Provider Demographics
NPI: | 1760511018 |
---|---|
Name: | TRASK MEDICAL CENTER |
Entity Type: | Organization |
Organization Name: | TRASK MEDICAL CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FIROOZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OMD, PT |
Authorized Official - Phone: | 714-890-3638 |
Mailing Address - Street 1: | 7040 TRASK AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | WESTMINSTER |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92683-2622 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-890-3638 |
Mailing Address - Fax: | 714-890-6012 |
Practice Address - Street 1: | 7040 TRASK AVE |
Practice Address - Street 2: | |
Practice Address - City: | WESTMINSTER |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92683-2622 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-890-3638 |
Practice Address - Fax: | 714-890-6012 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-04 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PT5610 | 111NX0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111NX0100X | Chiropractic Providers | Chiropractor | Occupational Health | Group - Multi-Specialty |