Basic Information
| Provider Information | |||||||||
| NPI: | 1184933830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTERS OF REHABILITATION & PAIN MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7170 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928344126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142237000 | ||||||||
| FaxNumber: | 7142237001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1041 E YORBA LINDA BLVD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928703728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142237000 | ||||||||
| FaxNumber: | 7142237001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2010 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | LAI | ||||||||
| AuthorizedOfficialFirstName: | ALBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7142237000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | A86192 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.