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General NPI Number Information
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NPI Number | 1760361794
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Entity Type | Organization
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Legal Business Name | LOOMIS GANG REHAB INC
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1130 W LA PALMA AVE
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City | ANAHEIM
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State | CA
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Zip | 92801-2803
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Country | US
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Telephone | 714-772-7480
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Fax |
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Provider Business Mailing Address
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Address Line | 6475 E PACIFIC COAST HWY # 746
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City | LONG BEACH
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State | CA
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Zip | 90803-4201
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Country | US
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Telephone | 949-533-0319
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | COLETTE THILKEN
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Credential |
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Telephone | 949-533-0319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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