Basic Information
| Provider Information | |||||||||
| NPI: | 1336714294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC COAST REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5319 UNIVERSITY DR # 136 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926122965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2247778034 | ||||||||
| FaxNumber: | 2242364900 | ||||||||
| Practice Location | |||||||||
| Address1: | 2181 CITRACADO PARKWAY | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925632415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4227761004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2021 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | AHAMED | ||||||||
| AuthorizedOfficialFirstName: | JAMEEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2247778034 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
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.