Provider Demographics
NPI:1871455212
Name:BARCENAS, JUSTIN TOBIAS
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TOBIAS
Last Name:BARCENAS
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 1:7045 LEICESTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1237
Mailing Address - Country:US
Mailing Address - Phone:909-217-1770
Mailing Address - Fax:
Practice Address - Street 1:7045 LEICESTER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1237
Practice Address - Country:US
Practice Address - Phone:909-217-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist