Basic Information
| Provider Information | |||||||||
| NPI: | 1154788628 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTERFACE REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 774 S PLACENTIA AVE | ||||||||
| Address2: | PLACENTIA | ||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928706832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008707989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 774 S PLACENTIA AVE | ||||||||
| Address2: | PLACENTIA | ||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928706832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008707989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2016 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | DESI | ||||||||
| AuthorizedOfficialFirstName: | ANNAT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8008707989 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 5670 | CA | Y | Hospitals | Rehabilitation Hospital |
No ID Information.