Healthcare Provider Details

I. General information

NPI: 1649876541
Provider Name (Legal Business Name): ATBA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2586 BUTHMANN AVE
TRACY CA
95376-2165
US

IV. Provider business mailing address

28202 CABOT RD STE 412
LAGUNA NIGUEL CA
92677-1271
US

V. Phone/Fax

Practice location:
  • Phone: 209-832-2273
  • Fax:
Mailing address:
  • Phone: 949-370-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY BRADSHAW
Title or Position: MANAGER
Credential:
Phone: 949-347-7100