1376566711 NPI number — CALIFORNIA REHAB GROUP

Table of content: (NPI 1376566711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376566711 NPI number — CALIFORNIA REHAB GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA REHAB GROUP
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:
1376566711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11024 BALBOA BLVD
Provider Second Line Business Mailing Address:
504
Provider Business Mailing Address City Name:
GRANADA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91344-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-634-6328
Provider Business Mailing Address Fax Number:
818-357-5574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11435 HAMLIN ST
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-634-6328
Provider Business Practice Location Address Fax Number:
818-357-5574
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
AILENE
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-634-6328

Provider Taxonomy Codes

  • Taxonomy code: 2251G0304X , with the licence number:  PT28631 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XN1300X , with the licence number: WOT2198 , 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)