=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780863605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P&A HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2007
-----------------------------------------------------
Last Update Date | 10/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E LINCOLN AVE STE 111
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-774-6502
-----------------------------------------------------
Fax | 714-774-0860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 HAMMOND STE C
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-1680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-770-6022
-----------------------------------------------------
Fax | 949-770-7084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALBERTO A. MARCIANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-770-6022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------