Active NPI
Juana Constantina Phillipp, M.D.
- Allergy Physician
- Glendora, CA
National Provider Identifier
1043358104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy Physician
- License
- A33955
- Practice address
- 130 W Route 66
Suite #220
Glendora, CA 91740-6249 - Phone
- (626) 914-5803
- NPI assigned
- Feb 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | A33955 | CA | Primary |
Addresses
Primary practice location
130 W Route 66
Suite #220
Glendora, CA 91740-6249
Mailing address
130 W Route 66
Suite #220
Glendora, CA 91740-6249
Phone (626) 914-5803
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OOA339550 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A33955 | CA | MD | Allergy Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213056000000",
"number": "1043358104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 W ROUTE 66",
"address_2": "SUITE #220",
"city": "GLENDORA",
"state": "CA",
"postal_code": "917406249",
"telephone_number": "626-914-5803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 W ROUTE 66",
"address_2": "SUITE #220",
"city": "GLENDORA",
"state": "CA",
"postal_code": "917406249",
"telephone_number": "626-914-5803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPP",
"first_name": "JUANA",
"middle_name": "CONSTANTINA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2008-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "207KA0200X",
"taxonomy_group": "",
"desc": "Allergy & Immunology, Allergy",
"state": "CA",
"license": "A33955",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OOA339550",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendora, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.