Provider Demographics
NPI:1821752320
Name:GRIFFINI, GUADALUPE YAWI (PTA)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:YAWI
Last Name:GRIFFINI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4377 WILSON AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1531
Mailing Address - Country:US
Mailing Address - Phone:619-947-1182
Mailing Address - Fax:
Practice Address - Street 1:9565 WAPLES ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2973
Practice Address - Country:US
Practice Address - Phone:858-695-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51385225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant