Healthcare Provider Details

I. General information

NPI: 1609880111
Provider Name (Legal Business Name): ARNOLD H TRIPP RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 MOUNTAIN PARK PLACE
ESCONDIDO CA
92027
US

IV. Provider business mailing address

PO BOX 268
ESCONDIDO CA
92033-0268
US

V. Phone/Fax

Practice location:
  • Phone: 760-738-8811
  • Fax: 760-738-8886
Mailing address:
  • Phone: 760-738-8811
  • Fax: 760-738-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3422
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberEN8
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: