Basic Information
| Provider Information | |||||||||
| NPI: | 1497966089 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A G REHAB CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6755 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928346755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519296260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12998 HESPERIA RD | ||||||||
| Address2: | SUITE NUMBER 103 | ||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923958316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602454800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 08/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHATURVEDI | ||||||||
| AuthorizedOfficialFirstName: | ARCHANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9519296260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OT7058 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.