Basic Information
Provider Information | |||||||||
NPI: | 1821183070 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HANDS ON HANDS REHABILITATION CENTER, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1700 ADAMS AVE STE 103 | ||||||||
Address2: |   | ||||||||
City: | COSTA MESA | ||||||||
State: | CA | ||||||||
PostalCode: | 926264865 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7145562288 | ||||||||
FaxNumber: | 7144351745 | ||||||||
Practice Location | |||||||||
Address1: | 1700 ADAMS AVE STE 103 | ||||||||
Address2: |   | ||||||||
City: | COSTA MESA | ||||||||
State: | CA | ||||||||
PostalCode: | 926264865 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7145562288 | ||||||||
FaxNumber: | 7144351745 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/04/2006 | ||||||||
LastUpdateDate: | 06/05/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ROYAL | ||||||||
AuthorizedOfficialFirstName: | JANET | ||||||||
AuthorizedOfficialMiddleName: | ELLEN | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 7145562288 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OT57 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
ID | Type | State | Issuer | Description | ZZZ64332Z | 01 | CA | BLUE SHIELD | OTHER |