Healthcare Provider Details

I. General information

NPI: 1033555347
Provider Name (Legal Business Name): THERAPIST SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 CONVOY ST STE 204
SAN DIEGO CA
92111-3744
US

IV. Provider business mailing address

3760 CONVOY ST STE 204
SAN DIEGO CA
92111-3744
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-0375
  • Fax: 858-514-0383
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number37371
License Number StateCA

VIII. Authorized Official

Name: MR. CONRADO LOBRIN CUASAY JR.
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 858-514-0375