Basic Information
| Provider Information | |||||||||
| NPI: | 1790928901 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEERSOFT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CA REHABILITATION SPECIALIST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11024 BALBOA BLVD | ||||||||
| Address2: | 504 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913445007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183633000 | ||||||||
| FaxNumber: | 8888332881 | ||||||||
| Practice Location | |||||||||
| Address1: | 10515 BALBOA BLVD | ||||||||
| Address2: | 285 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183633000 | ||||||||
| FaxNumber: | 8888332881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2009 | ||||||||
| LastUpdateDate: | 01/12/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | AILENE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8183633000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.