Healthcare Provider Details

I. General information

NPI: 1962401398
Provider Name (Legal Business Name): AIJ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 CENTER DR # E
LA MESA CA
91942-2952
US

IV. Provider business mailing address

8380 CENTER DR # E
LA MESA CA
91942-2952
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-6077
  • Fax: 619-466-6118
Mailing address:
  • Phone: 619-466-6077
  • Fax: 619-466-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27486
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number22847
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: TAMI PEAVY
Title or Position: CEO
Credential:
Phone: 619-466-6077