1114335080 NPI number — QUANTUM REHABCARE P.C.

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

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





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