Healthcare Provider Details

I. General information

NPI: 1194999540
Provider Name (Legal Business Name): BEVERLY HILLS HAND & REHAB CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SOUTH BEVERLY DRIVE 611
LOS ANGELES CA
90035
US

IV. Provider business mailing address

PO BOX 1586
SANTA BARBARA CA
93102-1586
US

V. Phone/Fax

Practice location:
  • Phone: 310-201-2016
  • Fax:
Mailing address:
  • Phone: 310-201-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN ANN LUCKETT
Title or Position: OWNER
Credential: OTR, CHT
Phone: 310-201-2016