Healthcare Provider Details

I. General information

NPI: 1841283850
Provider Name (Legal Business Name): CENTER FOR INDEPENDENT REHABILITATIVE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MOORPARK AVE STE. 230
SAN JOSE CA
95128-2654
US

IV. Provider business mailing address

2211 MOORPARK AVE STE. 230
SAN JOSE CA
95128-2654
US

V. Phone/Fax

Practice location:
  • Phone: 408-995-0144
  • Fax: 408-995-0121
Mailing address:
  • Phone: 408-995-0144
  • Fax: 408-995-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ERICA F BAHAM
Title or Position: MGR, ADMINISTRATIVE SERVICES
Credential:
Phone: 408-995-0144