MEDICARE: AUGUSTINE-JOHN MISA

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	225200000X	Physical Therapy Assistant	50319	CA

General Provider Information

NPI Number	:	1386591410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUSTINE-JOHN MISA

Provider Business Mailing Address
First Line	:	6801 PARK TER STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 PARK TER
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1543
Country	:	US
Telephone Number	:	310-665-7100
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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