Healthcare Provider Details

I. General information

NPI: 1174775183
Provider Name (Legal Business Name): MR. MARK STEVEN RASMUSSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 ATLANTIC AVE
LONG BEACH CA
90813-3403
US

IV. Provider business mailing address

709 S CENTRE ST APT 2
SAN PEDRO CA
90731-3732
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-0149
  • Fax: 562-285-0156
Mailing address:
  • Phone: 310-519-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: