Basic Information
| Provider Information | |||||||||
| NPI: | 1316447279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORTIMER | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 585 SATURN BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921544721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195911190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 585 SATURN BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921544721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195911190 | ||||||||
| FaxNumber: | 6195651656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2018 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 294491 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.