Provider Demographics
NPI:1598521700
Name:VENCES, MOISES JR (PTA)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:
Last Name:VENCES
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4203
Mailing Address - Country:US
Mailing Address - Phone:619-961-5555
Mailing Address - Fax:
Practice Address - Street 1:5030 CAMINO DE LA SIESTA STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3118
Practice Address - Country:US
Practice Address - Phone:619-260-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant