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NPI Code Detail

MEDICARE: MR. COLE PARKER SMITH CSCS, MTC

MEDICARE: MR. COLE PARKER SMITH CSCS, MTC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1184372310
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COLE PARKER SMITH CSCS, MTC
Provider Business Mailing Address
First Line : 9055 BALBOA AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1509
Country : US
Telephone Number : 831-915-5423
Fax Number :
Provider Business Practice Location Address
First Line : 9055 BALBOA AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1509
Country : US
Telephone Number : 831-915-5423
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2022
Last Update Date : 03/16/2022

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