Healthcare Provider Details

I. General information

NPI: 1023049970
Provider Name (Legal Business Name): REHABONE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13980 BLOSSOM HILL RD STE D
LOS GATOS CA
95032-5121
US

IV. Provider business mailing address

13980 BLOSSOM HILL RD STE D
LOS GATOS CA
95032-5121
US

V. Phone/Fax

Practice location:
  • Phone: 408-264-5570
  • Fax: 408-264-5576
Mailing address:
  • Phone: 408-264-5570
  • Fax: 408-264-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberCA20A6184
License Number StateCA

VIII. Authorized Official

Name: VERONICA DELGADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 408-264-5570