Provider Demographics
NPI:1326288358
Name:QUEST BIOFEEDBACK
Entity Type:Organization
Organization Name:QUEST BIOFEEDBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:CBS, CPMS,CSMS
Authorized Official - Phone:949-525-3254
Mailing Address - Street 1:5 GINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-5320
Mailing Address - Country:US
Mailing Address - Phone:949-525-3254
Mailing Address - Fax:949-888-6260
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:SUITE 336
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-525-3254
Practice Address - Fax:949-888-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty