Provider Demographics
NPI:1699273359
Name:HAGUE, PHILLIP JOSEPH
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JOSEPH
Last Name:HAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PHIL
Other - Middle Name:J
Other - Last Name:HAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1661 AMBERGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2941
Mailing Address - Country:US
Mailing Address - Phone:408-799-4910
Mailing Address - Fax:
Practice Address - Street 1:2001 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1136
Practice Address - Country:US
Practice Address - Phone:408-261-7777
Practice Address - Fax:408-259-2273
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator