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General NPI Number Information
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NPI Number | 1568046555
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Entity Type | Organization
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Legal Business Name | TRI STAR MEDICAL MANAGEMENT
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 802 N AVALON BLVD STE 2
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City | WILMINGTON
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State | CA
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Zip | 90744-4547
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Country | US
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Telephone | 562-444-5127
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Fax |
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Provider Business Mailing Address
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Address Line | 15741 WOODRUFF AVE STE B
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City | BELLFLOWER
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State | CA
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Zip | 90706-4083
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Country | US
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Telephone | 424-333-4896
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | SHARON LESSETT MARQUEZ
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Credential |
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Telephone | 424-333-4896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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