Healthcare Provider Details

I. General information

NPI: 1649436486
Provider Name (Legal Business Name): LLANTADA CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 BALBOA AVE STE 701
SAN DIEGO CA
92117-6930
US

IV. Provider business mailing address

5252 BALBOA AVE STE 701
SAN DIEGO CA
92117-6930
US

V. Phone/Fax

Practice location:
  • Phone: 858-384-6556
  • Fax: 858-225-8320
Mailing address:
  • Phone: 858-384-6556
  • Fax: 858-225-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCOR2360
License Number StateCA

VIII. Authorized Official

Name: RUMEL MENDOZA LLANTADA
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 858-384-6556