Provider Demographics
NPI:1770851578
Name:PHILLIPS, CATHY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E LATHAM AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4371
Mailing Address - Country:US
Mailing Address - Phone:951-658-9461
Mailing Address - Fax:
Practice Address - Street 1:720 E LATHAM AVE STE 1
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4371
Practice Address - Country:US
Practice Address - Phone:951-658-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17506363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ73069OtherMEDICARE PROVIDER NUMBER
AZP81733Medicare UPIN