Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G038878 | CA |
NPI | 1568512390 |
---|---|
Provider Name | Dr. John Terence Phillipp |
First Address | Glendora, CA 91740-6249 |
Second Address | Glendora, CA 91740-6249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G388780 | (05) | CA |
F12664 | (02) | CA |