Healthcare Provider Details

I. General information

NPI: 1871482570
Provider Name (Legal Business Name): MARK NOLAN WOINAROWICZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 EASTGATE MALL STE 120
SAN DIEGO CA
92121-1980
US

IV. Provider business mailing address

4435 NOBEL DR UNIT 1
SAN DIEGO CA
92122-1554
US

V. Phone/Fax

Practice location:
  • Phone: 858-587-8669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: