MEDICARE: FEHRENBACH, YOSHINO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT16850	CA

General Provider Information

NPI Number	:	1316170624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEHRENBACH, YOSHINO, LLC

Provider Business Mailing Address
First Line	:	777 CORPORATE DR
Second Line	:	SUITE 160
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-2135
Country	:	US
Telephone Number	:	949-472-2242
Fax Number	:	949-472-4501

Provider Business Practice Location Address
First Line	:	777 CORPORATE DR
Second Line	:	SUITE 160
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-2135
Country	:	US
Telephone Number	:	949-472-2242
Fax Number	:	949-472-4501

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. CHARLES FEHRENBACH
Credential	:	M.P.T.
Telephone Number	:	949-472-2242

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	09/02/2009

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