Healthcare Provider Details

I. General information

NPI: 1689116790
Provider Name (Legal Business Name): ERWIN MENGUITA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-7000
  • Fax:
Mailing address:
  • Phone: 760-633-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: