Healthcare Provider Details

I. General information

NPI: 1316990963
Provider Name (Legal Business Name): OPTIMAL REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S CATARACT AVE
SAN DIMAS CA
91773-2902
US

IV. Provider business mailing address

PO BOX 4586
ONTARIO CA
91761-0821
US

V. Phone/Fax

Practice location:
  • Phone: 909-394-0012
  • Fax: 909-305-1636
Mailing address:
  • Phone: 909-394-0012
  • Fax: 909-305-1636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMDR1803
License Number StateCA

VIII. Authorized Official

Name: PERRY J VIVES
Title or Position: PRESIDENT
Credential:
Phone: 909-394-0012