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PHOENIX JETT-DIAS
NPI 1114768280
Student in an Organized Health Care Education/Training Program in Modesto, CA

Active since June 03, 2024
3300 TULLY RD, MODESTO, CA 95350(209) 585-0555(209) 596-5142 Get Directions Write a Review

NPPES record last updated: July 25, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 17, 2024, Jun 3, 2024 (2 updates tracked since 2024).

About Phoenix Jett-dias NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHOENIX JETT-DIAS (NPI 1114768280) is an individual student in an organized health care education/training program in Modesto, California and active in the NPI registry since June 2024.

NPPES Registry Identity

NPI1114768280
Entity TypeIndividual
Primary Taxonomy390200000X
Provider Legal NamePHOENIX JETT-DIAS
Location Address3300 TULLY RDModesto, CA 95350-0836
Mailing Address3300 Tully Rd Ste B6Modesto, CA 95350-0848 · (209) 585-0555 · Fax (209) 596-5142
Phone(209) 585-0555
Fax(209) 596-5142
Sole ProprietorYes
Enumeration DateJune 3, 2024
Last NPPES UpdateJuly 25, 20252 updates tracked since enumeration
NPPES CertifiedJuly 25, 2025
✔ NPI 1114768280 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
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.
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
Also ListedSpecialistTaxonomy 174400000X
Also ListedPeer SpecialistTaxonomy 175T00000X
3300 TULLY RD, Modesto, CA 95350
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Other Names 1

Other Name (5)Phoenix Jett-dias

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. HENRY CISNEROS PHD
Counselor (Addiction (Substance Use Disorder))
3300 TULLY RD, SUITE D-5
MODESTO, CA 95350
Stanislaus County (209) 550-7444
DAWN M TERASHITA, PC
Community Health Worker
3300 TULLY RD, SUITE C-1
MODESTO, CA 95350
Stanislaus County (877) 358-8648
MS. JEANNE ELAINE ABBOTT LCSW
Social Worker
3300 TULLY RD, SUITE C-1
MODESTO, CA 95350
Stanislaus County (209) 529-2084
MR. DANIEL J. BRUCE L.C.S.W.
Social Worker (Clinical)
3300 TULLY RD, SUITE C-1
MODESTO, CA 95350
Stanislaus County (209) 529-2084
DOLORES CISNEROS
Counselor (Addiction (Substance Use Disorder))
3300 TULLY RD, SUITE D-5
MODESTO, CA 95350
Stanislaus County (209) 550-7444

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phoenix Jett-dias's NPI number?

The NPI number for Phoenix Jett-dias is 1114768280. It was assigned to this individual provider in the NPPES registry on June 3, 2024.

Where is Phoenix Jett-dias located?

Phoenix Jett-dias practices at 3300 Tully Rd, Modesto, CA 95350. The listed phone number is (209) 585-0555.

What is Phoenix Jett-dias's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Phoenix Jett-dias was last updated on July 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.