| NPI | 1114768280 |
|---|---|
| Other Name | PHOENIX JETT-DIAS |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 174400000X Specialist |
| 175T00000X Peer Specialist | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2025-07-25 |