OrganizationActive
Altered States Research Group, Inc.
NPI 1396995718 · Physical Medicine & Rehabilitation Physician · San Diego, CA
Provider details
- NPI number
- 1396995718
- Entity type
- Organization
- Primary specialty
- Physical Medicine & Rehabilitation PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Charles Knoll, Director(619) 481-8416
- License
- A100046 (CA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3511 Camino Del Rio S
Suite 404
San Diego, CA 92108-4003
Phone: (619) 481-8416
Fax: (619) 516-3993
Approximate (ZIP-level) locationGet directions
Mailing address
3511 Camino Del Rio S
San Diego, CA 92108-4003
Other names (DBA / former)
- Other name
- Asrg
Registry dates
- Enumerated
- 2008-09-22
- Last updated
- 2008-09-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.