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General NPI Number Information
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NPI Number | 1104423052
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Entity Type | Organization
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Legal Business Name | PREHAB LLC
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 10405 SD MSSN RD STE 103105
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City | SAN DIEGO
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State | CA
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Zip | 92108-2102
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Country | US
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Telephone | 646-403-6388
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Fax |
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Provider Business Mailing Address
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Address Line | 10405 SD MSSN RD STE 103105
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City | SAN DIEGO
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State | CA
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Zip | 92108-2102
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Country | US
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Telephone | 619-369-9442
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Fax | 213-336-3026
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Authorized Official
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Title or Position | OWNER
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Name | ALEX GOMETZ
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Credential | PT
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Telephone | 212-717-8330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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