Healthcare Provider Details

I. General information

NPI: 1336714294
Provider Name (Legal Business Name): PACIFIC COAST REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 CITRACADO PARKWAY
ESCONDIDO CA
92563-2415
US

IV. Provider business mailing address

1822 E ROUTE 66 STE A
GLENDORA CA
91740-3800
US

V. Phone/Fax

Practice location:
  • Phone: 422-776-1004
  • Fax:
Mailing address:
  • Phone: 760-790-7220
  • Fax: 760-227-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: RISHI SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 422-776-1004