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General NPI Number Information
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NPI Number | 1386794543
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Entity Type | Organization
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Legal Business Name | FORTUNA REHABILITATION
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 2648 MAIN ST SUITE BC
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City | CHULA VISTA
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State | CA
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Zip | 91911-4664
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Country | US
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Telephone | 619-575-0157
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Fax | 619-575-0053
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Provider Business Mailing Address
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Address Line | 2648 MAIN ST SUITE BC
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City | CHULA VISTA
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State | CA
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Zip | 91911-4664
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Country | US
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Telephone | 619-575-0157
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Fax | 619-575-0053
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Authorized Official
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Title or Position | CFO, COO
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Name | DONNELLA GOODWIN
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Credential | MBA
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Telephone | 619-575-0157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 056863
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License Number State | CA
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