Healthcare Provider Details

I. General information

NPI: 1043736879
Provider Name (Legal Business Name): DAVID SEBASTIAN MIGNEA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BROADWAY STE 2
CHULA VISTA CA
91910-3502
US

IV. Provider business mailing address

320 BROADWAY STE 2
CHULA VISTA CA
91910-3502
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-0404
  • Fax: 619-422-4153
Mailing address:
  • Phone: 619-422-0404
  • Fax: 619-422-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: