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NPI Code Detail

MEDICARE: MS. PRIMROSE HAZEL PISARES M.S., ATC

MEDICARE: MS. PRIMROSE HAZEL PISARES M.S., ATC
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 : 1912971839
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PRIMROSE HAZEL PISARES M.S., ATC
Provider Business Mailing Address
First Line : 1106 REDWOOD PL
Second Line :
City : SALINAS
State : CA
Zip : 93901-1825
Country : US
Telephone Number : 831-596-2056
Fax Number :
Provider Business Practice Location Address
First Line : 1156 HIGH ST
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95064-1077
Country : US
Telephone Number : 831-459-4793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 07/08/2007

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