Provider Demographics
NPI:1295138642
Name:PHOENIX HEALTH SOLUTIONS
Entity type:Organization
Organization Name:PHOENIX HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-709-6826
Mailing Address - Street 1:245 TERRACINA BLVD
Mailing Address - Street 2:SUITE 211B
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4852
Mailing Address - Country:US
Mailing Address - Phone:909-709-6826
Mailing Address - Fax:909-798-9329
Practice Address - Street 1:245 TERRACINA BLVD
Practice Address - Street 2:SUITE 211B
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4852
Practice Address - Country:US
Practice Address - Phone:909-709-6826
Practice Address - Fax:909-798-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66921261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care