Provider Demographics
NPI:1578250445
Name:ROJAS, PHILLIP P
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:P
Last Name:ROJAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVER DR STE 234
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5515
Mailing Address - Country:US
Mailing Address - Phone:949-642-8193
Mailing Address - Fax:949-325-0817
Practice Address - Street 1:901 DOVER DR STE 234
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5515
Practice Address - Country:US
Practice Address - Phone:949-642-8193
Practice Address - Fax:949-325-0817
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24826225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist