Healthcare Provider Details

I. General information

NPI: 1366361719
Provider Name (Legal Business Name): BIOHACK WELLNESS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

9245 SKY PARK CT STE 130
SAN DIEGO CA
92123-4388
US

IV. Provider business mailing address

9245 SKY PARK CT STE 130
SAN DIEGO CA
92123-4388
US

V. Phone/Fax

Practice location:
  • Phone: 619-289-7788
  • Fax:
Mailing address:
  • Phone: 619-289-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNABELL CATANIA
Title or Position: CEO
Credential:
Phone: 619-289-7788