Healthcare Provider Details

I. General information

NPI: 1649637968
Provider Name (Legal Business Name): SOUTH PACIFIC REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2016
Last Update Date: 01/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD
ENCINO CA
91436-2203
US

IV. Provider business mailing address

16260 VENTURA BLVD
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: KATHERINE DUQUE
Title or Position: SLP
Credential: M.S. CCC
Phone: 818-986-1977