NEUROTRACE (NPI# 1073968582) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073968582 |
| Entity Type | Organization |
| Organization Name | NEUROTRACE |
| Practice Address |
4611 Virginia Ave San Diego CA 92115-4130 |
| Practice Telephone | 8058573995 |
| Practice Fax Number | 3102806998 |
| Mailing Telephone | 8058573995 |
| Mailing Fax Number | 3102806998 |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2016-05-03 |
| Authorized Official Name | ARNOLD HERBERT TRIPP (OWNER) |
| Authorized Official Telephone | 8058573995 |
| Authorized Official Credential | P.T. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
WPT3422A | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | PHYSICAL THERAPY LICENSE | WPT3422A | 01 |
| Street Address |
4611 VIRGINIA AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92115-4130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790313922 | Mayra Ailed Bugarin | Student in an Organized Health Care Education/Training Program | City Heights Family Health Center 5454, El Cajon Blvd, San Diego, CA 92115 | 2020-04-01 |
| 1093369878 | Chang Liu | Counselor | 3539 College Avenue, San Diego, CA 92115 | 2019-07-30 |
| 1689238560 | Donia Ahadian | Student in an Organized Health Care Education/Training Program | City Heights Family Health Center, 5454 El Cajon Blvd, San Diego, CA 92115 | 2019-04-26 |
| 1780157859 | James Michael Sites | Military Health Care Provider | Uss Shoup Ddg 86, San Diego, CA 92115 | 2019-01-10 |
| 1780163006 | Marcos Luis Sandoval | Case Manager/Care Coordinator | 6224 El Cajon Blvd, Suite 17, San Diego, CA 92115 | 2018-08-08 |
| 1437651981 | Phyllis Lynette Pryor | Licensed Vocational Nurse | 4974 El Cajon Blvd Suite A, San Diego, CA 92115 | 2018-03-01 |
| 1982125605 | Ellen Medical Transport | Non-emergency Medical Transport (VAN) | 4587 Winona Ave #5, San Diego, CA 92115 | 2017-07-03 |
| 1992225296 | P'okot LLC | Non-emergency Medical Transport (VAN) | 5511 Adelaide Ave, 26, San Diego, CA 92115 | 2017-06-27 |
| 1578019840 | Alfred Zygmunt Nowak | Specialist/Technologist | 6663 Reservoir Ln, San Diego, CA 92115 | 2016-08-28 |
| 1639534183 | Kalkaal Financial Enterprise, LLC. | Non-emergency Medical Transport (VAN) | 5055 Collwood Blvd., Unit 108, San Diego, CA 92115 | 2015-12-29 |
| Find all providers in zip 92115 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245847540 | Bespoke San Diego Physical Therapy PC | Clinic/Center | 2748 Ariane Dr, Unit 141, San Diego, CA 92117-3407 | 2020-09-30 |
| 1972163426 | Digital Health Physical Therapy Corp | Clinic/Center | 225 Broadway Ste 300, San Diego, CA 92101-5010 | 2019-06-17 |
| 1750842829 | Five Star Rehabilitation and Wellness Services, LLC. | Clinic/Center | 16925 Hierba Dr, San Diego, CA 92128-2688 | 2019-03-29 |
| 1285126599 | Mel's Physical Therapy, Inc. | Clinic/Center | 5621 Dwight St, San Diego, CA 92105-3843 | 2018-06-01 |
| 1215424213 | New Phyzio Physical Therapy, PC | Clinic/Center | 10801 Thornmint Rd Ste 250, San Diego, CA 92127-2421 | 2018-04-16 |
| 1578082319 | Therapy South, PC | Clinic/Center | 4850 Coronado Ave, San Diego, CA 92107-3316 | 2017-09-13 |
| 1194241679 | Carter Ryan Phillips | Clinic/Center | 3535 General Atomics Ct, San Diego, CA 92121-1140 | 2017-08-16 |
| 1639574189 | Functional Capacity Interventions | Clinic/Center | 4947 Twain Ave, San Diego, CA 92120-4217 | 2014-10-27 |
| 1639573116 | Restoration Physical Therapy | Clinic/Center | 870 Diamond St Apt 105, San Diego, CA 92109-2557 | 2014-10-13 |
| 1124456868 | Catalyst Physical Therapy & Wellness, Inc. | Clinic/Center | 1333 Camino Del Rio S Ste 103, San Diego, CA 92108-3520 | 2013-10-16 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.