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General NPI Number Information
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NPI Number | 1124758396
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Entity Type | Organization
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Legal Business Name | CJ PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/12/2022
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Last Update Date | 06/12/2022
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Provider Practice Location Address
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Address Line | 49613 HARRISON ST STE A105
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City | COACHELLA
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State | CA
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Zip | 92236-1451
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Country | US
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Telephone | 760-501-6541
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Fax |
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Provider Business Mailing Address
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Address Line | 84410 ONDA DR
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City | INDIO
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State | CA
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Zip | 92203-2910
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Country | US
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Telephone | 760-342-5501
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DR. DAN JAMES RARELA
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Credential | DPT
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Telephone | 760-501-6541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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