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General NPI Number Information
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NPI Number | 1144431073
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Entity Type | Organization
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Legal Business Name | BRAVO REHAB SERVICES, INC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 409 S LA BREA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-2321
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Country | US
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Telephone | 818-545-3709
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Fax | 818-827-3350
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Provider Business Mailing Address
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Address Line | 1254 NORTH EVERETT ST.
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City | GLENDALE
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State | CA
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Zip | 91207
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Country | US
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Telephone | 818-545-3709
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Fax | 818-827-3350
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAY LOMIBAO PADILLO
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Credential |
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Telephone | 818-245-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 28175
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License Number State | CA
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