Healthcare Provider Details

I. General information

NPI: 1144536574
Provider Name (Legal Business Name): COLLABORATIVE MEDICAL REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 BUCKINGHAM BLVD
BERKELEY CA
94705-1713
US

IV. Provider business mailing address

7030 BUCKINGHAM BLVD
BERKELEY CA
94705-1713
US

V. Phone/Fax

Practice location:
  • Phone: 510-964-0458
  • Fax:
Mailing address:
  • Phone: 510-964-0458
  • Fax: 510-964-0476

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: KATHY A ELGOHARY
Title or Position: PRINCIPAL OFFICER
Credential:
Phone: 510-964-0458