Healthcare Provider Details

I. General information

NPI: 1538445119
Provider Name (Legal Business Name): SOUTH PACIFIC REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 VAN NUYS BLVD 301
SHERMAN OAKS CA
91403-1700
US

IV. Provider business mailing address

16260 VENTURA BLVD 600
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-5050
  • Fax: 818-990-9449
Mailing address:
  • Phone: 818-986-1977
  • Fax: 818-986-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB COHEN
Title or Position: OWNER
Credential:
Phone: 818-986-1977