Healthcare Provider Details

I. General information

NPI: 1659685139
Provider Name (Legal Business Name): SYRISA METZGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

1420 VINE ST
SAN DIEGO CA
92103-4707
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-6590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT5857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: