Individual
KEVIN MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, EMT-B
Contact information
Practice address
1100 N GRAND AVE, WALNUT, CA 91789-1399
(909) 274-6555
Mailing address
9610 LONGDEN AVE, TEMPLE CITY, CA 91780-1447
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
E115899
CA
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
03/12/2018
Last updated
02/13/2020
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