MEDICARE: LA CORF SERVICES INC

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	054544	CA

General Provider Information

NPI Number	:	1487649125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA CORF SERVICES INC

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	#820
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-250-2673
Fax Number	:	213-250-2633

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	#820
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-250-2673
Fax Number	:	213-250-2633

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEKSANDR BLYUMKIN
Credential	:
Telephone Number	:	213-250-2673

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/22/2020

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Directions to “LA CORF SERVICES INC ” Practice Location

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