Healthcare Provider Details

I. General information

NPI: 1871421123
Provider Name (Legal Business Name): JASON LUEVANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N TWIN OAKS VALLEY RD STE 111
SAN MARCOS CA
92069-2954
US

IV. Provider business mailing address

405 N TWIN OAKS VALLEY RD STE 111
SAN MARCOS CA
92069-2954
US

V. Phone/Fax

Practice location:
  • Phone: 760-653-2683
  • Fax: 866-813-1235
Mailing address:
  • Phone: 760-653-2683
  • Fax: 866-813-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: