Organization
NEUROTRACE
Active
Organization
NEUROTRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARNOLD HERBERT TRIPP P.T. (OWNER)
(805) 857-3995
Entity
Organization
Contact information
Practice address
4611 VIRGINIA AVE, SAN DIEGO, CA 92115-4130
(805) 857-3995
(310) 280-6998
Mailing address
4611 VIRGINIA AVE, SAN DIEGO, CA 92115-4130
(805) 857-3995
(310) 280-6998
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
WPT3422A
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WPT3422A
PHYSICAL THERAPY LICENSE
CA
Enumeration date
05/03/2016
Last updated
05/03/2016
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