1366707929 NPI number — CENTERS OF REHABILITATION & PAIN MEDICINE, 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 1366707929 NPI number — CENTERS OF REHABILITATION & PAIN MEDICINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERS OF REHABILITATION & PAIN MEDICINE, 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:
6
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:
1366707929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2980 N BEVERLY GLEN CIR
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90077-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-474-9809
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1041 E YORBA LINDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-3728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-223-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
BAO
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
714-223-7000

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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