Healthcare Provider Details

I. General information

NPI: 1184714883
Provider Name (Legal Business Name): CPRX, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3662 KATELLA AVE SUITE 105
LOS ALAMITOS CA
90720-3124
US

IV. Provider business mailing address

3662 KATELLA AVE SUITE 105
LOS ALAMITOS CA
90720-3124
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-4494
  • Fax: 562-280-0304
Mailing address:
  • Phone: 562-799-4494
  • Fax: 562-280-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEREMY W MATTESON
Title or Position: OWNER/PRESIDENT
Credential: PT, CSCS
Phone: 562-799-4494