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General NPI Number Information
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NPI Number | 1366436396
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Entity Type | Organization
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Legal Business Name | IRVINE PHYSICAL MEDICINE & REHABILITATION A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 18124 CULVER DR SUITE F
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City | IRVINE
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State | CA
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Zip | 92612-2729
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Country | US
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Telephone | 949-552-9393
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Fax | 949-552-5872
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Provider Business Mailing Address
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Address Line | 18124 CULVER DR SUITE F
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City | IRVINE
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State | CA
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Zip | 92612-2729
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Country | US
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Telephone | 949-552-9393
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Fax | 949-552-5872
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MISS DAIZY GUTIERREZ
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Credential |
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Telephone | 949-552-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | DC24241
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License Number State | CA
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