Healthcare Provider Details

I. General information

NPI: 1538922026
Provider Name (Legal Business Name): ALEXANDER RENE GARDUNO-TURINCIO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 GREENFIELD DR
EL CAJON CA
92021-3520
US

IV. Provider business mailing address

1250 PETREE ST APT 377
EL CAJON CA
92020-2444
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-5752
  • Fax:
Mailing address:
  • Phone: 760-750-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: