Healthcare Provider Details

I. General information

NPI: 1962238436
Provider Name (Legal Business Name): TIMOTHY RASMUSSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 W AVENUE K
LANCASTER CA
93536-5426
US

IV. Provider business mailing address

6015 W AVENUE J3
LANCASTER CA
93536-7527
US

V. Phone/Fax

Practice location:
  • Phone: 661-722-6300
  • Fax:
Mailing address:
  • Phone: 626-484-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: