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General NPI Number Information
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NPI Number | 1497233522
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Entity Type | Organization
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Legal Business Name | PURE SPORTS MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 4300 TRADEWINDS DR STE 300
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City | OXNARD
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State | CA
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Zip | 93035-1458
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Country | US
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Telephone | 805-815-3399
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 TRADEWINDS DR STE 300
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City | OXNARD
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State | CA
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Zip | 93035-1458
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Country | US
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Telephone | 805-815-3399
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ATMAN REYES
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Credential | MD
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Telephone | 805-815-3399
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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 |
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License Number State |
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