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General NPI Number Information
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NPI Number | 1528554029
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Entity Type | Organization
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Legal Business Name | ALTADENA REHAB LLC
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Dates
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Enumeration Date | 07/08/2018
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Last Update Date | 12/22/2018
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Provider Practice Location Address
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Address Line | 2070 CEDAR GLEN DR
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City | CORONA
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State | CA
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Zip | 92879-7839
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Country | US
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Telephone | 949-419-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 2070 CEDAR GLEN DR
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City | CORONA
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State | CA
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Zip | 92879-7839
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Country | US
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Telephone | 949-419-5500
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | DENA TAHMASEB ZAMANIAN
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Credential | OTR/L
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Telephone | 951-298-9647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 11673
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License Number State | CA
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