Individual provider · Type 1 NPI

Phoenix Jett-Dias

Student in an Organized Health Care Education/Training Program · Modesto, CA

NPI number 1114768280 Active

Practice location

3300 Tully Rd
Modesto, CA 95350-0836

Call (209) 585-0555 Map

Fax (209) 596-5142

Mailing address

3300 Tully Rd Ste B6
Modesto, CA 95350-0848

Specialties and licenses

TaxonomyCodeLicense
Specialist 174400000XNone listed
Peer Specialist 175T00000XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed
Case Manager/Care Coordinator 171M00000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

5 other providers at this address

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About NPI 1114768280

Phoenix Jett-Dias's National Provider Identifier is 1114768280, issued on Jun 3, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Modesto, CA. The record was last updated on Jul 25, 2025.