Provider Demographics
NPI:1972020097
Name:PLEBAN, ANNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PLEBAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 CAMINO MIRA DEL MAR UNIT 218
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2569
Mailing Address - Country:US
Mailing Address - Phone:203-906-6190
Mailing Address - Fax:
Practice Address - Street 1:3633 VISTA WAY STE 101
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4568
Practice Address - Country:US
Practice Address - Phone:760-729-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist