Healthcare Provider Details

I. General information

NPI: 1053234187
Provider Name (Legal Business Name): CALIFORNIA REHAB PHYSICIANS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9571 HIGHWAY 9
BEN LOMOND CA
95005-9269
US

IV. Provider business mailing address

9571 HIGHWAY 9
BEN LOMOND CA
95005-9269
US

V. Phone/Fax

Practice location:
  • Phone: 831-216-6156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL NEUDORF
Title or Position: PRESIDENT/CEO
Credential: DO
Phone: 949-290-5053