Provider Demographics
NPI:1427545326
Name:PHILLIPS, ALLISON (CNC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 CERRITOS DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2818
Mailing Address - Country:US
Mailing Address - Phone:949-831-3801
Mailing Address - Fax:949-831-3801
Practice Address - Street 1:1427 CERRITOS DR
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2818
Practice Address - Country:US
Practice Address - Phone:949-831-3801
Practice Address - Fax:949-831-3801
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education