Provider Demographics
NPI:1588832307
Name:CONCEPCION, KIRK (AT,C)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VEREDA LEYENDA
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117
Mailing Address - Country:US
Mailing Address - Phone:714-315-3783
Mailing Address - Fax:
Practice Address - Street 1:7070 MARKETPLACE DRIVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117
Practice Address - Country:US
Practice Address - Phone:805-685-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer