Healthcare Provider Details

I. General information

NPI: 1154390888
Provider Name (Legal Business Name): MICHAEL NMN SKURJA JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPTIAL, NEUROLOGY DEPARTMENT BOX 555191
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

12337 REATA CT
SAN DIEGO CA
92128-1251
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1384
  • Fax: 760-725-1411
Mailing address:
  • Phone: 858-592-9504
  • Fax: 858-451-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 005817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: