Healthcare Provider Details

I. General information

NPI: 1497672554
Provider Name (Legal Business Name): OLAJUAN MIGUEL LOWERY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 MURPHY CANYON RD
SAN DIEGO CA
92123-4320
US

IV. Provider business mailing address

5255 NUTMEG ST
SAN DIEGO CA
92105-4953
US

V. Phone/Fax

Practice location:
  • Phone: 619-753-5933
  • Fax:
Mailing address:
  • Phone: 336-999-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: