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General NPI Number Information
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NPI Number | 1487649125
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Entity Type | Organization
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Legal Business Name | LA CORF SERVICES INC
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1127 WILSHIRE BLVD #820
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City | LOS ANGELES
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State | CA
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Zip | 90017-3901
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Country | US
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Telephone | 213-250-2673
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Fax | 213-250-2633
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Provider Business Mailing Address
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Address Line | 1127 WILSHIRE BLVD #820
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City | LOS ANGELES
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State | CA
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Zip | 90017-3901
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Country | US
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Telephone | 213-250-2673
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Fax | 213-250-2633
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALEKSANDR BLYUMKIN
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Credential |
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Telephone | 213-250-2673
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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 | 054544
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License Number State | CA
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