Healthcare Provider Details

I. General information

NPI: 1679635569
Provider Name (Legal Business Name): REIMAGINE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E SAINT ANDREW PL
SANTA ANA CA
92705-4940
US

IV. Provider business mailing address

1601 E SAINT ANDREW PL
SANTA ANA CA
92705-4940
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-7400
  • Fax: 714-633-0738
Mailing address:
  • Phone: 714-633-7400
  • Fax: 714-633-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberI24111L
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SOFIA CELESTINA MARTINEZ
Title or Position: CHIEF OF PROGRAMS & SERVICES
Credential: LCSW
Phone: 714-680-6060