Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A16990 | CA |
N | 207VX0000X | Obstetrician | 20A16990 | CA |
NPI | 1104213271 |
---|---|
Provider Name | Jazma Phelps |
First Address | Victorville, CA 92395-5794 |
Second Address | Victorville, CA 92395-5794 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 09/09/2021 |