Healthcare Provider Details

I. General information

NPI: 1659199883
Provider Name (Legal Business Name): PROPRIOCEPTIVE HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 VILLA LA JOLLA DR
LA JOLLA CA
92037-1732
US

IV. Provider business mailing address

1206 FIG CT
NATIONAL CITY CA
91950-1645
US

V. Phone/Fax

Practice location:
  • Phone: 858-223-9942
  • Fax:
Mailing address:
  • Phone: 858-223-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL
# 7
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: PHILIP A. ANDREW CROCHEN
Title or Position: CEO
Credential: DHSC
Phone: 619-852-4783