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General NPI Number Information
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NPI Number | 1447705538
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Entity Type | Organization
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Legal Business Name | NEW LIFE REHAB AND ACUPUNCTURE, INC
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 9161 SIERRA AVE
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City | FONTANA
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State | CA
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Zip | 92335-4729
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Country | US
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Telephone | 909-428-6882
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Fax |
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Provider Business Mailing Address
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Address Line | 9161 SIERRA AVE
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City | FONTANA
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State | CA
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Zip | 92335-4729
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Country | US
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Telephone | 909-428-6882
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ASHLEY BENZ TRINO
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Credential | PT
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Telephone | 310-701-4349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 053961
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License Number State | CA
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