1205362662 NPI number — OC REHAB, A MEDICAL GROUP, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205362662 NPI number — OC REHAB, A MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OC REHAB, A MEDICAL GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205362662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIMAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91773-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-971-9334
Provider Business Mailing Address Fax Number:
909-575-3573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15191 BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-373-4555
Provider Business Practice Location Address Fax Number:
714-459-8777
Provider Enumeration Date:
05/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
714-803-5607

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT38543 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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