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General NPI Number Information
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NPI Number | 1114335080
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Entity Type | Organization
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Legal Business Name | QUANTUM REHABCARE P.C.
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 13352 HAWTHORNE BLVD SUITE B
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City | HAWTHORNE
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State | CA
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Zip | 90250-5805
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Country | US
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Telephone | 310-679-1890
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Fax | 310-679-1898
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. TYSON LANDEZA
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Credential | M.D.
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Telephone | 310-679-1890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A92168
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A92168
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License Number State | CA
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