Trace Edward Fleming

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Kerman, CA

NPI 1063907673 · NPPES record last updated Jun 26, 2018

Key facts

NPI
1063907673
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
13038 W Annadale Ave
Kerman, CA 93630-9102
Phone
(559) 283-7421
NPI assigned
Jun 26, 2018
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

13038 W Annadale Ave
Kerman, CA 93630-9102

Mailing address

13038 W Annadale Ave
Kerman, CA 93630-9102
Phone (559) 283-7421

Other providers in Kerman, CA

All providers in Kerman, CA · Student in an Organized Health Care Education/Training Program in California

Sources for this page

Verify at the official NPI Registry.