Healthcare Provider Details

I. General information

NPI: 1215129366
Provider Name (Legal Business Name): SOUTHWEST REHAB SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W COLE BLVD SUITE B
CALEXICO CA
92231-9700
US

IV. Provider business mailing address

2300 ASHTON CT
IMPERIAL CA
92251-8803
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-7877
  • Fax:
Mailing address:
  • Phone: 760-455-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROMULO J GARCIA
Title or Position: OWNER
Credential: PTA
Phone: 760-455-3306