1114335080 NPI number — QUANTUM REHABCARE P.C.

Table of content: (NPI 1114335080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114335080 NPI number — QUANTUM REHABCARE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUANTUM REHABCARE P.C.
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:
1114335080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90510-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-792-3914
Provider Business Mailing Address Fax Number:
855-898-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13352 HAWTHORNE BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90250-5805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-679-1890
Provider Business Practice Location Address Fax Number:
310-679-1898
Provider Enumeration Date:
07/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LANDEZA
Authorized Official First Name:
TYSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
310-679-1890

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  A92168 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: A92168 , 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)





Copyright © 2007-2025 www.npivalidator.com