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General NPI Number Information
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NPI Number | 1093046286
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Entity Type | Organization
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Legal Business Name | PRISTINE REHAB CARE
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 706 N DIAMOND BAR BLVD STE B
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1059
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Country | US
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Telephone | 909-396-8900
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Fax | 909-396-9900
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Provider Business Mailing Address
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Address Line | 706 N DIAMOND BAR BLVD STE B
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1059
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Country | US
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Telephone | 909-396-8900
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Fax | 909-396-9900
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KISHORE KANTAMANENI
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Credential |
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Telephone | 909-396-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | CA
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