Healthcare Provider Details

I. General information

NPI: 1629934971
Provider Name (Legal Business Name): ADRIAN IMPERIAL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 KEMPTON ST
SPRING VALLEY CA
91977-5810
US

IV. Provider business mailing address

325 KEMPTON ST
SPRING VALLEY CA
91977-5810
US

V. Phone/Fax

Practice location:
  • Phone: 877-344-2671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number50717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: