Healthcare Provider Details

I. General information

NPI: 1568046555
Provider Name (Legal Business Name): TRI STAR MEDICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N AVALON BLVD STE 2
WILMINGTON CA
90744-4547
US

IV. Provider business mailing address

15741 WOODRUFF AVE STE B
BELLFLOWER CA
90706-4083
US

V. Phone/Fax

Practice location:
  • Phone: 562-444-5127
  • Fax:
Mailing address:
  • Phone: 424-333-4896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARON LESSETT MARQUEZ
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 424-333-4896