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General NPI Number Information
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NPI Number | 1861070062
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Entity Type | Organization
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Legal Business Name | PRO TO COL SPORT SYSTEMS
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 2949 GARNET AVE FL 3
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City | SAN DIEGO
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State | CA
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Zip | 92109-3826
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Country | US
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Telephone | 619-255-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 2949 GARNET AVE FL 3
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City | SAN DIEGO
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State | CA
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Zip | 92109-3826
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Country | US
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Telephone | 619-255-5577
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MRS. JULIE A PITOIS
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Credential |
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Telephone | 619-255-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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