Healthcare Provider Details

I. General information

NPI: 1669572707
Provider Name (Legal Business Name): SOUTH PACIFIC REHABILITATION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTH CITRUS AVE, SUITE 203
AZUSA CA
91702-5911
US

IV. Provider business mailing address

16260 VENTURA BLVD STE 600
ENCINO CA
91436-4604
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-6514
  • Fax: 626-339-6573
Mailing address:
  • Phone: 818-986-1977
  • Fax: 818-986-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CALVIN IYOYA
Title or Position: CHIEF OPERATION OFFICER
Credential:
Phone: 818-986-1977