Healthcare Provider Details

I. General information

NPI: 1639302136
Provider Name (Legal Business Name): EXECUTIVE HAND THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TUSTIN AVE SUITE 401
SANTA ANA CA
92705-3813
US

IV. Provider business mailing address

400 N TUSTIN AVE SUITE 401
SANTA ANA CA
92705-3813
US

V. Phone/Fax

Practice location:
  • Phone: 714-564-8210
  • Fax: 714-564-8306
Mailing address:
  • Phone: 714-564-8210
  • Fax: 714-564-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RON YARON GOLDSTEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-564-8210