Healthcare Provider Details

I. General information

NPI: 1154614030
Provider Name (Legal Business Name): CALIFORNIA MEDICAL INJURY & REHABILITATION PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 H ST SUITE 2020
CHULA VISTA CA
91910-5555
US

IV. Provider business mailing address

333 H ST SUITE 2020
CHULA VISTA CA
91910-5555
US

V. Phone/Fax

Practice location:
  • Phone: 619-713-7406
  • Fax: 619-923-2632
Mailing address:
  • Phone: 619-713-7406
  • Fax: 619-923-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBINSON R LANGILLE
Title or Position: OWNER/VICE PRESIDENT
Credential: DC
Phone: 619-713-7406