Healthcare Provider Details

I. General information

NPI: 1447205828
Provider Name (Legal Business Name): SOUTH PACIFIC REHABILITATION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44303 LOWTREE AVE
LANCASTER CA
93534-4149
US

IV. Provider business mailing address

16260 VENTURA BLVD, STE 600
ENCINO CA
91436-4604
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-5494
  • Fax: 661-940-0825
Mailing address:
  • Phone: 818-976-1977
  • Fax: 818-986-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CALVIN IYOYA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 818-986-1977