Healthcare Provider Details

I. General information

NPI: 1245969609
Provider Name (Legal Business Name): QUALIFIED MED EVAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E COLORADO BLVD STE 711
PASADENA CA
91101-1911
US

IV. Provider business mailing address

3435 E THOUSAND OAKS BLVD UNIT 3157
THOUSAND OAKS CA
91359-7908
US

V. Phone/Fax

Practice location:
  • Phone: 916-996-0099
  • Fax:
Mailing address:
  • Phone: 916-996-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: ADAM BARKER
Title or Position: CEO
Credential:
Phone: 916-996-0099