MEDICARE: TECBEC INC A MEDICAL PROFESSIONAL CORPORATION

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
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1659132546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TECBEC INC A MEDICAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 872
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91376-0872
Country	:	US
Telephone Number	:	818-518-7226
Fax Number	:	818-671-2225

Provider Business Practice Location Address
First Line	:	15717 BELLE DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1439
Country	:	US
Telephone Number	:	571-331-9620
Fax Number	:	818-671-2225

Authorized Official
Title or Position	:	OWNER
Name	:	BRENDAN CONROY
Credential	:	MD
Telephone Number	:	571-331-9620

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

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