Healthcare Provider Details

I. General information

NPI: 1578459673
Provider Name (Legal Business Name): MONTECITO OUTPATIENT REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E BROWN RD
MESA AZ
85207-3901
US

IV. Provider business mailing address

8035 E BROWN RD
MESA AZ
85207-3901
US

V. Phone/Fax

Practice location:
  • Phone: 520-727-1868
  • Fax: 480-591-6888
Mailing address:
  • Phone: 520-727-1868
  • Fax: 480-591-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: SECRETARY
Credential:
Phone: 949-540-1249