Provider Demographics
NPI:1528676269
Name:TRAUMA & STRESS RECOVERY, A MEDICAL GROUP INC.
Entity type:Organization
Organization Name:TRAUMA & STRESS RECOVERY, A MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASUELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-346-8640
Mailing Address - Street 1:500 12TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4005
Mailing Address - Country:US
Mailing Address - Phone:415-346-8640
Mailing Address - Fax:415-563-2273
Practice Address - Street 1:500 12TH ST STE 110
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4005
Practice Address - Country:US
Practice Address - Phone:415-346-8640
Practice Address - Fax:415-563-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty