Provider Demographics
NPI:1598823882
Name:AYUB, EDWARD (RPT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:AYUB
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 ROSECRANS ST
Mailing Address - Street 2:#F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:619-223-7175
Mailing Address - Fax:619-223-7030
Practice Address - Street 1:3145 ROSECRANS ST
Practice Address - Street 2:#F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-223-7175
Practice Address - Fax:619-223-7030
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5573225100000X
CAPT5573A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT5573AMedicare PIN
CAPT5573Medicare PIN