Provider Demographics
NPI:1174775183
Name:RASMUSSEN, MARK STEVEN
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVEN
Last Name:RASMUSSEN
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 1:709 S CENTRE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3732
Mailing Address - Country:US
Mailing Address - Phone:310-519-1868
Mailing Address - Fax:
Practice Address - Street 1:1078 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3403
Practice Address - Country:US
Practice Address - Phone:562-285-0149
Practice Address - Fax:562-285-0156
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner