Healthcare Provider Details

I. General information

NPI: 1457433633
Provider Name (Legal Business Name): ALICIA R TRAKTMAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCI MEDICAL CENTER 101 THE CITY DRIVE SOUTH
ORANGE CA
92868
US

IV. Provider business mailing address

UNIVERSITY HEAD & NECK SURGEON PO BOX 513700
LOS ANGELES CA
90051-3700
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-2986
  • Fax:
Mailing address:
  • Phone: 714-456-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number000000AU1556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: