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General NPI Number Information
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NPI Number | 1578755633
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Entity Type | Organization
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Legal Business Name | SOUTHWEST REHAB SPECIALIST
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 437 GRAPE AVE
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City | HOLTVILLE
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State | CA
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Zip | 92250-1505
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Country | US
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Telephone | 760-455-3306
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 ASHTON CT
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City | IMPERIAL
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State | CA
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Zip | 92251-8803
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Country | US
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Telephone | 760-455-3306
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROMULO GARCIA
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Credential | PTA
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Telephone | 760-455-3306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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