Basic Information
| Provider Information | |||||||||
| NPI: | 1992887616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST COAST SPINE RESTORATION CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6177 RIVER CREST DR. | ||||||||
| Address2: | #A | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
| FaxNumber: | 9516535051 | ||||||||
| Practice Location | |||||||||
| Address1: | 6177 RIVER CREST DR. | ||||||||
| Address2: | #A | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
| FaxNumber: | 9516535051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | KISHINO | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9516534480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251H1200X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.