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General NPI Number Information
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NPI Number | 1912334889
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Entity Type | Organization
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Legal Business Name | CONCENTRA
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 9405 FAIRWAY VIEW PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0932
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Country | US
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Telephone | 909-987-3037
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 POEMA DR
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City | COLTON
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State | CA
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Zip | 92324-1961
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Country | US
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Telephone |
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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 | MRS. ASHLEY PACLEB LANGAS
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Credential | M.O.T.
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Telephone | 808-990-5229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 13575
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License Number State | CA
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