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General NPI Number Information
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NPI Number | 1144549429
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Entity Type | Organization
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Legal Business Name | PERFORMANCE SPORTS CLINIC
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 16615 LARK AVE SUITE 203
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City | LOS GATOS
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State | CA
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Zip | 95032-7645
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Country | US
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Telephone | 408-402-3427
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Fax |
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Provider Business Mailing Address
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Address Line | 16615 LARK AVE SUITE 203
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City | LOS GATOS
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State | CA
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Zip | 95032-7645
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Country | US
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Telephone | 408-402-3427
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SAUNDRA COBOS NAMIMATSU
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Credential | D.C.
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Telephone | 408-402-3427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 32460
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License Number State | CA
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