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General NPI Number Information
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NPI Number | 1184746927
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Entity Type | Organization
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Legal Business Name | GATEWAY REHAB & WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 24002 VIA FABRICANTE SUITE 501
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City | MISSION VIEJO
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State | CA
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Zip | 92691-3901
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Country | US
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Telephone | 949-454-8811
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Fax | 949-454-8833
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Provider Business Mailing Address
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Address Line | 24002 VIA FABRICANTE SUITE 501
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City | MISSION VIEJO
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State | CA
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Zip | 92691-3901
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Country | US
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Telephone | 949-454-8811
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Fax | 949-454-8833
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR ROBERT RAFA
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Credential | D.C.
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Telephone | 949-454-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-28755
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-28726
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G060299
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License Number State | CA
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