Healthcare Provider Details

I. General information

NPI: 1467498139
Provider Name (Legal Business Name): JEFF PARKAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17272 NEWHOPE ST SUITE G
FOUNTAIN VALLEY CA
92708-4210
US

IV. Provider business mailing address

PO BOX 8125
FOUNTAIN VALLEY CA
92728-8125
US

V. Phone/Fax

Practice location:
  • Phone: 714-638-8693
  • Fax: 714-638-3940
Mailing address:
  • Phone: 714-638-8693
  • Fax: 714-638-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberPT30067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: