Healthcare Provider Details

I. General information

NPI: 1639907744
Provider Name (Legal Business Name): SEAN MICHAEL CONBOY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N BELLFLOWER BLVD
LONG BEACH CA
90840-0004
US

IV. Provider business mailing address

650 TAMARACK AVE APT 3912
BREA CA
92821-3253
US

V. Phone/Fax

Practice location:
  • Phone: 562-985-4111
  • Fax:
Mailing address:
  • Phone: 719-359-0715
  • 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: