Provider Demographics
NPI:1932111820
Name:ELUMBA, JOSEPH RONALDO (MPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RONALDO
Last Name:ELUMBA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 STYLE DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-8090
Mailing Address - Country:US
Mailing Address - Phone:949-700-1958
Mailing Address - Fax:949-215-1961
Practice Address - Street 1:28 STYLE DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-8090
Practice Address - Country:US
Practice Address - Phone:949-300-3423
Practice Address - Fax:949-215-1961
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT224232251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19723Medicare PIN