Provider Demographics
NPI:1457114365
Name:PHILLIPS, XAVIER LAMANCE
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:LAMANCE
Last Name:PHILLIPS
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 1:14101 MARQUESAS WAY APT 4321
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7460
Mailing Address - Country:US
Mailing Address - Phone:864-704-2142
Mailing Address - Fax:
Practice Address - Street 1:14101 MARQUESAS WAY APT 4321
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7460
Practice Address - Country:US
Practice Address - Phone:864-704-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343800000X
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)