Healthcare Provider Details

I. General information

NPI: 1558454926
Provider Name (Legal Business Name): MARCIA G KLAIBER MA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 CAMPANILE DRIVE SDSU EXERCISE AND NUTRITIONAL SCIENCES
SAN DIEGO CA
92182-7251
US

IV. Provider business mailing address

229 FARGO GLEN
ESCONDIDO CA
92027
US

V. Phone/Fax

Practice location:
  • Phone: 619-594-4094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: