Basic Information
| Provider Information | |||||||||
| NPI: | 1689702755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROTTER | ||||||||
| FirstName: | BROCK | ||||||||
| MiddleName: | ELI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 E WALNUT ST FL 3 | ||||||||
| Address2: | PHR GROUP PROVIDER ENROLLMENT UNIT | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776080044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2151 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933054113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618687160 | ||||||||
| FaxNumber: | 6618687172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.