1720475825 NPI number — NEURO-REHAB CONSULTATION & TREATMENT SERVICES

Table of content: (NPI 1720475825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720475825 NPI number — NEURO-REHAB CONSULTATION & TREATMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEURO-REHAB CONSULTATION & TREATMENT SERVICES
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:
1720475825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 E GREEN ST
Provider Second Line Business Mailing Address:
#422
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-710-7838
Provider Business Mailing Address Fax Number:
626-270-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 S RAYMOND AVE
Provider Second Line Business Practice Location Address:
#340
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-710-7838
Provider Business Practice Location Address Fax Number:
626-270-4234
Provider Enumeration Date:
04/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MIKAEL
Authorized Official First Name:
MONA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
626-710-7838

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  25089 , 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