Basic Information
| Provider Information | |||||||||
| NPI: | 1447205828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH PACIFIC REHABILITATION SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16260 VENTURA BLVD, STE 600 | ||||||||
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| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914364604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189761977 | ||||||||
| FaxNumber: | 8189864757 | ||||||||
| Practice Location | |||||||||
| Address1: | 44303 LOWTREE AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619405494 | ||||||||
| FaxNumber: | 6619400825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | IYOYA | ||||||||
| AuthorizedOfficialFirstName: | CALVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8189861977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.