Healthcare Provider Details

I. General information

NPI: 1376306761
Provider Name (Legal Business Name): AVAYA THERAPY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SPECTRUM CENTER DR STE 400
IRVINE CA
92618-4989
US

IV. Provider business mailing address

300 SPECTRUM CENTER DR STE 400
IRVINE CA
92618-4989
US

V. Phone/Fax

Practice location:
  • Phone: 312-404-9639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROLANDO G ARROJO
Title or Position: PRESIDENT
Credential:
Phone: 312-404-9639