MEDICARE: HELYN-KEZIAH EJANDA EXALA PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	309663	CA

General Provider Information

NPI Number	:	1316891096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELYN-KEZIAH EJANDA EXALA PT, DPT

Provider Business Mailing Address
First Line	:	10767 JAMACHA BLVD SPC 22
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1846
Country	:	US
Telephone Number	:	619-991-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 SATURN BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-4735
Country	:	US
Telephone Number	:	619-591-1190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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