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General NPI Number Information
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NPI Number | 1285590158
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Entity Type | Individual
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Provider Name | JUAN MANDUJANO
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Gender | Male
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 260 E MARKET ST
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City | LONG BEACH
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State | CA
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Zip | 90805
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Country | US
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Telephone | 562-428-4681
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Fax |
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Provider Business Mailing Address
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Address Line | 3369 JOSEPHINE STREET
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City | LYNWOOD
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State | CA
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Zip | 90262
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Country | US
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Telephone | 562-980-0334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 53636
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License Number State | CA
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