Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Phoenix Jett-Dias

Individual provider Specialist · NPI 1114768280

Phoenix Jett-Dias is a Specialist in Modesto, California. Practices as a sole proprietor. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
4
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Practice location Address checks out

3300 Tully Rd
Modesto, CA 95350-0836
Phone: (209) 585-0555
Fax: (209) 596-5142
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X
Specialist Taxonomy 174400000X
Peer Specialist Taxonomy 175T00000X
Case Manager/Care Coordinator Taxonomy 171M00000X

Record details

NPI number1114768280
Entity typeIndividual (Type 1)
GenderNot disclosed
Sole proprietorYes
NPI enumeratedJune 3, 2024
Last updated in NPPESJuly 25, 2025
Certification dateJuly 25, 2025
Mailing address3300 Tully Rd Ste B6, Modesto, CA 95350-0848

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