Healthcare Provider Details

I. General information

NPI: 1699830851
Provider Name (Legal Business Name): REHABNET OUTPATIENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 04/22/2009
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: 714-731-2441
  • Fax: 714-596-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4968070001
License Number StateCA

VIII. Authorized Official

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