Provider Demographics
NPI:1194370072
Name:TUESTA, ERICK (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:TUESTA
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MARIN ST # 313
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4115
Mailing Address - Country:US
Mailing Address - Phone:805-864-2711
Mailing Address - Fax:
Practice Address - Street 1:15420 COBALT ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-2731
Practice Address - Country:US
Practice Address - Phone:800-600-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer