Healthcare Provider Details

I. General information

NPI: 1811517352
Provider Name (Legal Business Name): ANTHONY MICHAEL MUJICA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30837 E THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-4039
US

IV. Provider business mailing address

56 MAEGAN PL APT 1
THOUSAND OAKS CA
91362-2774
US

V. Phone/Fax

Practice location:
  • Phone: 818-879-2091
  • Fax:
Mailing address:
  • Phone: 328-238-7647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number48299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: