=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083030589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAYER PHYSICAL THERAPIST MISSION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2014
-----------------------------------------------------
Last Update Date | 03/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1359 HAVEN TREE LN
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92881-0703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-905-0293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1359 HAVEN TREE LN
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92881-0703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-905-0293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NAYER RAGHEB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-905-0293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 27539
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------