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General NPI Number Information
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NPI Number | 1730362203
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Entity Type | Organization
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Legal Business Name | EXODUS HEALTHCARE, INC.
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 6445 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-5808
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Country | US
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Telephone | 619-265-0400
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Fax | 619-265-0440
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Provider Business Mailing Address
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Address Line | 6445 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-5808
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Country | US
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Telephone | 619-265-0400
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Fax | 619-265-0440
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVEN MICHAEL GREEN
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Credential |
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Telephone | 619-265-0400
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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 | W19528
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License Number State | CA
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