Healthcare Provider Details

I. General information

NPI: 1437194628
Provider Name (Legal Business Name): HUNTINGTON REHABILITATION MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S. RAYMOND AVE STE #120
PASADENA CA
91105-3036
US

IV. Provider business mailing address

630 S. RAYMOND AVE STE #120
PASADENA CA
91105-3036
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-1444
  • Fax: 626-403-1448
Mailing address:
  • Phone: 626-403-1444
  • Fax: 626-403-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNIL KUMAR HEGDE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-403-1444