MEDICARE: MONTECITO OUTPATIENT REHABILITATION LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist
4	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1578459673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTECITO OUTPATIENT REHABILITATION LLC

Provider Business Mailing Address
First Line	:	8035 E BROWN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3901
Country	:	US
Telephone Number	:	520-727-1868
Fax Number	:	480-591-6888

Provider Business Practice Location Address
First Line	:	8035 E BROWN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3901
Country	:	US
Telephone Number	:	520-727-1868
Fax Number	:	480-591-6888

Authorized Official
Title or Position	:	SECRETARY
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	02/10/2026

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