Provider Demographics
NPI:1821532474
Name:TRAVIS D TRAMEL RDHAP, INC
Entity Type:Organization
Organization Name:TRAVIS D TRAMEL RDHAP, INC
Other - Org Name:GERISMILES HYGIENE PRACTICE OF TRAVIS TRAMEL RDHAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:951-757-9964
Mailing Address - Street 1:4199 FLAT ROCK DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-7115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4199 FLAT ROCK DR
Practice Address - Street 2:SUITE 127
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7115
Practice Address - Country:US
Practice Address - Phone:951-428-1714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP588302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization