Provider Demographics
NPI:1447671821
Name:SEOK, TRISTAN I (DPT)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:I
Last Name:SEOK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2310
Mailing Address - Country:US
Mailing Address - Phone:760-591-7750
Mailing Address - Fax:760-294-9813
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:STE 185
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-591-7750
Practice Address - Fax:760-294-9813
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB222506OtherMEDICARE PTAN
CACB222509OtherMEDICARE PTAN
CACB222508OtherMEDICARE PTAN
CACB222511OtherMEDICARE PTAN
CACB222507OtherMEDICARE PTAN
CACB222510OtherMEDICARE PTAN
CACB222505OtherMEDICARE PTAN
CACB222511OtherMEDICARE PTAN