Healthcare Provider Details

I. General information

NPI: 1538788054
Provider Name (Legal Business Name): ADVANCE OCCUPATIONAL & HAND THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 BROOKHOLLOW DR STE 37
SANTA ANA CA
92705-5427
US

IV. Provider business mailing address

22 ODYSSEY STE 165
IRVINE CA
92618-3194
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-7330
  • Fax: 949-727-2193
Mailing address:
  • Phone: 949-727-2192
  • Fax: 949-727-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROSS REZAEI
Title or Position: PRESIDENT
Credential: OTR/L,HTC
Phone: 949-727-2192