Healthcare Provider Details

I. General information

NPI: 1386591410
Provider Name (Legal Business Name): AUGUSTINE-JOHN MISA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER
LOS ANGELES CA
90045-1543
US

IV. Provider business mailing address

6801 PARK TER STE 200
LOS ANGELES CA
90045-1546
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: