Provider Demographics
NPI:1114356375
Name:CORPUZ, MARK (BS KINESIOLOGY,CSCS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CORPUZ
Suffix:
Gender:M
Credentials:BS KINESIOLOGY,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12817
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92112-3817
Mailing Address - Country:US
Mailing Address - Phone:619-263-0239
Mailing Address - Fax:619-858-2210
Practice Address - Street 1:2464 FENTON PKWY APT 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6705
Practice Address - Country:US
Practice Address - Phone:619-263-0239
Practice Address - Fax:619-858-2210
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist