Healthcare Provider Details

I. General information

NPI: 1326288358
Provider Name (Legal Business Name): QUEST BIOFEEDBACK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27001 LA PAZ RD SUITE 336
MISSION VIEJO CA
92691-5502
US

IV. Provider business mailing address

5 GINGHAM ST
TRABUCO CANYON CA
92679-5320
US

V. Phone/Fax

Practice location:
  • Phone: 949-525-3254
  • Fax: 949-888-6260
Mailing address:
  • Phone: 949-525-3254
  • Fax: 949-888-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY GRANT SWANSON
Title or Position: CEO/PRESIDENT
Credential: CBS, CPMS,CSMS
Phone: 949-525-3254