1083641013 NPI number — MISS TRICIA MIKIKO KASAMATSU ATC

Table of content: MISS TRICIA MIKIKO KASAMATSU ATC (NPI 1083641013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083641013 NPI number — MISS TRICIA MIKIKO KASAMATSU ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASAMATSU
Provider First Name:
TRICIA
Provider Middle Name:
MIKIKO
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083641013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 N STATE COLLEGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92831-3547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
657-278-7206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N STATE COLLEGE BLVD
Provider Second Line Business Practice Location Address:
ATTN: KINESIOLOGY
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92831-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-278-7206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)