Healthcare Provider Details

I. General information

NPI: 1497417869
Provider Name (Legal Business Name): TRACEY A ENGLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 S TREMONT ST
OCEANSIDE CA
92054-5309
US

IV. Provider business mailing address

29605 SOLANA WAY APT U08
TEMECULA CA
92591-3761
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-2800
  • Fax: 760-263-6217
Mailing address:
  • Phone: 760-439-2800
  • Fax: 760-263-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: