Neurotrace

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

WPT3422A Issued in CA

Legal business name

NEUROTRACE

Practice address

4611 Virginia Ave
San Diego, CA 92115-4130

Phone

(805) 857-3995

Fax

(310) 280-6998

NPI assigned

May 3, 2016

Last updated

May 3, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Arnold Herbert Tripp, P.T.

Title

Owner

Phone

(805) 857-3995

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462233600000",
    "number": "1073968582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4611 VIRGINIA AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921154130",
            "telephone_number": "805-857-3995",
            "fax_number": "310-280-6998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4611 VIRGINIA AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921154130",
            "telephone_number": "805-857-3995",
            "fax_number": "310-280-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROTRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2016-05-03",
        "status": "A",
        "authorized_official_last_name": "TRIPP",
        "authorized_official_first_name": "ARNOLD",
        "authorized_official_middle_name": "HERBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-857-3995",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "WPT3422A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "WPT3422A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neurophysiology Inc.
• Neuroscience and Behavioral Health Services
• Neurosound, Inc.
• Neurosphere and Audiology Inc (Neurosphere)
• Neurosurgical Medical Clinic, Inc,
• John Neustadt, N.D.
• Alejandra Nevarez Nunez
• Angelyne Nicole Nevarez
• Anya Ithel Nevarez, LCSW
• Hector Nevarez, LVN

• Physical Therapy Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.