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General NPI Number Information
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NPI Number | 1568701282
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Entity Type | Organization
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Legal Business Name | SELECT COMPCARE
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 225 W HOSPITALITY LN STUITE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3256
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Country | US
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Telephone | 909-890-3699
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Fax | 909-890-4395
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Provider Business Mailing Address
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Address Line | 225 W HOSPITALITY LN STUITE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3256
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Country | US
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Telephone | 909-890-3699
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Fax | 909-890-4395
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Authorized Official
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Title or Position | MANAGER
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Name | THOMAS HOBSON
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Credential |
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Telephone | 909-890-3699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 20A8134
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License Number State | CA
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