Healthcare Provider Details

I. General information

NPI: 1447671821
Provider Name (Legal Business Name): TRISTAN I SEOK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W VISTA WAY STE 185
VISTA CA
92083-6031
US

IV. Provider business mailing address

3070 MADISON ST
CARLSBAD CA
92008-2310
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-7750
  • Fax: 760-294-9813
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-294-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: