Healthcare Provider Details

I. General information

NPI: 1982728564
Provider Name (Legal Business Name): DESIGNER HEALTH & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 MAIN ST
IRVINE CA
92614-4795
US

IV. Provider business mailing address

17777 MAIN ST
IRVINE CA
92614-4795
US

V. Phone/Fax

Practice location:
  • Phone: 949-433-5000
  • Fax: 949-660-1512
Mailing address:
  • Phone: 949-433-5000
  • Fax: 949-660-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number15396
License Number StateCA

VIII. Authorized Official

Name: DR. CAROL R SOLOWAY
Title or Position: SECRETARY
Credential: DC
Phone: 949-433-5000