Phillips, Maryanne Deforest

Phillips, Maryanne Deforest is an sole proprietor health care provider with primary practice located at 5052 Jones Blvd 135, Las Vegas NV 89118. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Phillips, Maryanne Deforest can be contacted via phone (702) 822-1881.

Contact Information

Primary practice address
5052 Jones Blvd 135 Las Vegas NV 89118
Phone: (702) 822-1881
Fax: (702) 822-1880
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 7635 Nevada

Profile Details

NPI number 1780698456
LBN Legal business name Phillips, Maryanne Deforest
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 28th, 2006
Last updated Apr 13th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780698456 NPPES
California Other 00A637530 BLUE SHIELD
California MEDICAID 00A637530 BLUE SHIELD

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