Healthcare Provider Details

I. General information

NPI: 1841395340
Provider Name (Legal Business Name): MAHNAZ N KAZALBASCH R.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14566 SEVENTH ST
VICTORVILLE CA
92395-4214
US

IV. Provider business mailing address

24 HAMMOND STE C
IRVINE CA
92618-1680
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-0895
  • Fax: 760-843-0894
Mailing address:
  • Phone: 949-770-6022
  • Fax: 949-770-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: