Healthcare Provider Details

I. General information

NPI: 1568035418
Provider Name (Legal Business Name): JASON OLIVEROS UYAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 E IMPERIAL HWY
BREA CA
92821-6713
US

IV. Provider business mailing address

19025 TERESA WAY
CERRITOS CA
90703-7125
US

V. Phone/Fax

Practice location:
  • Phone: 714-578-8720
  • Fax:
Mailing address:
  • Phone: 562-253-9071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: