Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95011464 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 95011464 | CA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95011464 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 839048 | NV |
N | 363LG0600X | Nurse Practitioner - Gerontology | 95011464 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95011464 | CA |
NPI | 1437612538 |
---|---|
Provider Name | Ronald E Phillips |
First Address | Los Angeles, CA 90026-3080 |
Second Address | Los Angeles, CA 90015-3316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2019 |
Last Update Date | 05/04/2021 |