Healthcare Provider Details

I. General information

NPI: 1568701282
Provider Name (Legal Business Name): SELECT COMPCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W HOSPITALITY LN STUITE 200
SAN BERNARDINO CA
92408-3256
US

IV. Provider business mailing address

225 W HOSPITALITY LN STUITE 200
SAN BERNARDINO CA
92408-3256
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-3699
  • Fax: 909-890-4395
Mailing address:
  • Phone: 909-890-3699
  • Fax: 909-890-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A8134
License Number StateCA

VIII. Authorized Official

Name: THOMAS HOBSON
Title or Position: MANAGER
Credential:
Phone: 909-890-3699