Provider Demographics
NPI:1447528666
Name:PHILLIPS, JESSICA LOLA
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LOLA
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 1:124 RIVER RD
Mailing Address - Street 2:KINSHIP CENTER
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-9601
Mailing Address - Country:US
Mailing Address - Phone:831-455-9965
Mailing Address - Fax:831-455-4777
Practice Address - Street 1:2214 N MAIN ST
Practice Address - Street 2:KINSHIP CENTER FAMILY TIES
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-1516
Practice Address - Country:US
Practice Address - Phone:831-443-0662
Practice Address - Fax:831-443-0668
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other