1336209659 NPI number — CALIFORNIA NEURO-REHABILITATION INSTITUTE, INC.

Table of content: MR. MICHAEL ROBERT HALSTEAD M.D. (NPI 1922427749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336209659 NPI number — CALIFORNIA NEURO-REHABILITATION INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA NEURO-REHABILITATION INSTITUTE, 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:
1336209659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S VIRGIL AVE
Provider Second Line Business Mailing Address:
#401
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90020-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-480-0021
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S VIRGIL AVE
Provider Second Line Business Practice Location Address:
#401
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-480-0021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
SEONWEON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
213-480-0021

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  32717 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 27249 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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