Provider Demographics
NPI:1790356624
Name:MEREGINI, JORDAN CHUKWUEMEKA
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHUKWUEMEKA
Last Name:MEREGINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10538 MISSION GORGE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3154
Mailing Address - Country:US
Mailing Address - Phone:469-865-3012
Mailing Address - Fax:
Practice Address - Street 1:10538 MISSION GORGE RD STE 120
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3154
Practice Address - Country:US
Practice Address - Phone:619-312-6109
Practice Address - Fax:619-312-6110
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3061702251X0800X
TX1349362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic