Healthcare Provider Details

I. General information

NPI: 1386747830
Provider Name (Legal Business Name): TOTAL REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 17 ST STE 204
SANTA ANA CA
92701
US

IV. Provider business mailing address

1206 E 17 ST STE 204
SANTA ANA CA
92701
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-2454
  • Fax: 714-835-4619
Mailing address:
  • Phone: 714-619-2454
  • Fax: 714-835-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DIMITRI SIRAKOFF
Title or Position: PRESIDENT
Credential:
Phone: 714-619-2454