Healthcare Provider Details

I. General information

NPI: 1386363315
Provider Name (Legal Business Name): ANTHONY TRABACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 PAJARO ST
SALINAS CA
93901-3459
US

IV. Provider business mailing address

141 14TH ST
PACIFIC GROVE CA
93950-2734
US

V. Phone/Fax

Practice location:
  • Phone: 800-214-5439
  • Fax:
Mailing address:
  • Phone: 831-869-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: