Basic Information
| Provider Information | |||||||||
| NPI: | 1992753842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLOTZ | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR 1ST | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163792726 | ||||||||
| FaxNumber: | 9168537874 | ||||||||
| Practice Location | |||||||||
| Address1: | 699 W TEFFT ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NIPOMO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934449289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059309995 | ||||||||
| FaxNumber: | 8059295771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 049327 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A063826 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1174556286 | 05 | CA | MEDICAID |