Healthcare Provider Details

I. General information

NPI: 1760920888
Provider Name (Legal Business Name): ANDREW OHNERSORGEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 ROSECRANS ST STE F
SAN DIEGO CA
92110-4831
US

IV. Provider business mailing address

3145 ROSECRANS ST STE F
SAN DIEGO CA
92110-4831
US

V. Phone/Fax

Practice location:
  • Phone: 619-223-7175
  • Fax:
Mailing address:
  • Phone: 619-223-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT292300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: