Healthcare Provider Details

I. General information

NPI: 1760361794
Provider Name (Legal Business Name): LOOMIS GANG REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W LA PALMA AVE
ANAHEIM CA
92801-2803
US

IV. Provider business mailing address

6475 E PACIFIC COAST HWY # 746
LONG BEACH CA
90803-4201
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-7480
  • Fax:
Mailing address:
  • Phone: 949-533-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: COLETTE THILKEN
Title or Position: MANAGER
Credential:
Phone: 949-533-0319