Healthcare Provider Details

I. General information

NPI: 1366707929
Provider Name (Legal Business Name): CENTERS OF REHABILITATION & PAIN MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD SUITE 210
PLACENTIA CA
92870-3728
US

IV. Provider business mailing address

2980 N BEVERLY GLEN CIR SUITE 301
LOS ANGELES CA
90077-1726
US

V. Phone/Fax

Practice location:
  • Phone: 714-223-7000
  • Fax:
Mailing address:
  • Phone: 310-474-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. BAO T. NGUYEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 714-223-7000