Healthcare Provider Details

I. General information

NPI: 1821532474
Provider Name (Legal Business Name): TRAVIS D TRAMEL RDHAP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 FLAT ROCK DR SUITE 127
RIVERSIDE CA
92505-7115
US

IV. Provider business mailing address

4199 FLAT ROCK DR SUITE 127
RIVERSIDE CA
92505-7115
US

V. Phone/Fax

Practice location:
  • Phone: 951-428-1714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberHAP588
License Number StateCA

VIII. Authorized Official

Name: TRAVIS TRAMEL
Title or Position: CEO
Credential: RDHAP
Phone: 951-757-9964