Basic Information
| Provider Information | |||||||||
| NPI: | 1023449741 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED REHAB CONSULTANTS CALIFORNIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N MICHIGAN AVE | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247778034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7716 W MANCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | PLAYA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902938408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247778034 | ||||||||
| FaxNumber: | 3108234694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2013 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | AMISH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2247778034 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INTEGRATED REHAB CONSULTANTS LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.