Provider Demographics
NPI:1023641958
Name:HELLSUND, MARK ERIC
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ERIC
Last Name:HELLSUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48745 3 POINTS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HUGHES
Mailing Address - State:CA
Mailing Address - Zip Code:93532-1122
Mailing Address - Country:US
Mailing Address - Phone:661-724-0001
Mailing Address - Fax:
Practice Address - Street 1:48745 3 POINTS RD
Practice Address - Street 2:
Practice Address - City:LAKE HUGHES
Practice Address - State:CA
Practice Address - Zip Code:93532-1122
Practice Address - Country:US
Practice Address - Phone:661-724-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78274247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other