Individual ProviderPhoenix Bullis-CaballosCounselorBehavioral Health & Social Service ProvidersPractice Address1106 Nikki View Dr, Brandon, FL 33511-4868(813) 680-1367(813) 593-7053PECOS EnrollmentBased on the most recent information from CMS, provider Phoenix Bullis-Caballos does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:06 AM.Profile DetailsProvider ID1871302919Provider TypeIndividualFull NameBullis-Caballos, PhoenixGenderMaleSole ProprietorNoEnumeration Date1/3/2025Last Updated4/30/2025Contact InformationPractice LocationPractice Address1106 Nikki View Dr, Brandon, FL 33511-4868Phone(813) 680-1367FaxUnlisted FaxMailing LocationMailing Address10914 Le Jardin Cir Apt 102, Temple Terrace, FL 33617-2810Phone(813) 593-7053FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseISW19019Florida