Healthcare Provider Details

I. General information

NPI: 1992740476
Provider Name (Legal Business Name): JOSEPH STANLEY PARRY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5998 ALCALA PARK
SAN DIEGO CA
92110-2476
US

IV. Provider business mailing address

18782 CAMINITO CANTILENA 137
SAN DIEGO CA
92128-6122
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-8895
  • Fax: 619-260-4742
Mailing address:
  • Phone: 858-336-7159
  • Fax: 619-260-4742

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: