Basic Information
| Provider Information | |||||||||
| NPI: | 1710595830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHAB WAVE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7090 CAMINITO LA BENERA | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920375715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132345837 | ||||||||
| FaxNumber: | 7137017295 | ||||||||
| Practice Location | |||||||||
| Address1: | 7760 PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919422028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132345837 | ||||||||
| FaxNumber: | 7137017295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2020 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | ZAINAB | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7132774475 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
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.