Healthcare Provider Details

I. General information

NPI: 1972020097
Provider Name (Legal Business Name): ANNA PLEBAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 VISTA WAY STE 101
OCEANSIDE CA
92056-4568
US

IV. Provider business mailing address

12655 CAMINO MIRA DEL MAR UNIT 218
SAN DIEGO CA
92130-2569
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-7298
  • Fax:
Mailing address:
  • Phone: 203-906-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: