Healthcare Provider Details

I. General information

NPI: 1902489248
Provider Name (Legal Business Name): MICHAEL D ERMATINGER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12455 KERRAN ST
POWAY CA
92064-8834
US

IV. Provider business mailing address

1606 EBERS ST
SAN DIEGO CA
92107-3545
US

V. Phone/Fax

Practice location:
  • Phone: 714-336-0963
  • Fax:
Mailing address:
  • Phone: 619-679-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: