Healthcare Provider Details

I. General information

NPI: 1750489274
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA MOBILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST SUITE 900
SANTA MONICA CA
90404-1135
US

IV. Provider business mailing address

18368 ENTERPRISE LN
HUNTINGTON BEACH CA
92648-1201
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-2292
  • Fax:
Mailing address:
  • Phone: 714-596-9400
  • Fax: 714-596-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29608
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27278
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10329
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27292
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4602
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5715
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23946
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26142
License Number StateCA

VIII. Authorized Official

Name: TIMOTHY F DE COU
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-596-9400