Provider Demographics
NPI:1740852201
Name:PHILLIPS, VICTORIA ASHLEY
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ASHLEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S HORNE ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6016
Mailing Address - Country:US
Mailing Address - Phone:760-681-6942
Mailing Address - Fax:
Practice Address - Street 1:220 S BARNWELL ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4507
Practice Address - Country:US
Practice Address - Phone:619-246-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1223744OtherDRIVER LICENSE