1093746752 NPI number — ADVANCE OCCUPATIONAL & HAND THERAPY CENTER

Table of content: (NPI 1093746752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093746752 NPI number — ADVANCE OCCUPATIONAL & HAND THERAPY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE OCCUPATIONAL & HAND THERAPY CENTER
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:
SEVEN TO 7 PHYSICAL & HAND THERAPY
Provider Other Organization Name Type Code:
3
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:
1093746752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 ODYSSEY
Provider Second Line Business Mailing Address:
SUITE #: 165
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-3186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-727-2192
Provider Business Mailing Address Fax Number:
949-727-2193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ODYSSEY STE 165
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-285-3098
Provider Business Practice Location Address Fax Number:
949-727-2193
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REZAEI
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-727-2192

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT38428 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT33635 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: OT1251 , 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)

  • Identifier: 3791439 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OT0012510 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ64792Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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