Healthcare Provider Details

I. General information

NPI: 1629031711
Provider Name (Legal Business Name): MARK ANDREW POCINICH ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WATTS WAY
LOS ANGELES CA
90089-0604
US

IV. Provider business mailing address

2923 SILVA ST
LAKEWOOD CA
90712-2936
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-5845
  • Fax: 213-740-0504
Mailing address:
  • Phone: 562-408-3569
  • 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: