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General NPI Number Information
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NPI Number | 1538835244
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Entity Type | Individual
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Provider Name | ELIJAH AXEL MORIN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2021
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Last Update Date | 08/22/2021
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Provider Practice Location Address
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Address Line | 7425 MISSION VALLEY RD STE 201
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City | SAN DIEGO
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State | CA
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Zip | 92108-4409
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Country | US
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Telephone | 619-219-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 RIVER RUN DR UNIT 64
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City | SAN DIEGO
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State | CA
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Zip | 92108-5812
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Country | US
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Telephone | 732-407-8651
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 300734
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License Number State | CA
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