Healthcare Provider Details

I. General information

NPI: 1487687455
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA REHABILITATION MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST 5TH FLOOR NORTH TOWER
BURBANK CA
91505-4809
US

IV. Provider business mailing address

PO BOX 5171
WEST HILLS CA
91308-5171
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-3200
  • Fax: 818-847-3205
Mailing address:
  • Phone: 818-847-3200
  • Fax: 818-847-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CLARICE CAIRNS
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-847-3200