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NPI Code Detail

MEDICARE: SOUTHWEST REHAB SPECIALIST

MEDICARE: SOUTHWEST REHAB SPECIALIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist
2261Q00000XClinic/Center

General Provider Information

NPI Number : 1215129366
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWEST REHAB SPECIALIST
Provider Business Mailing Address
First Line : 2300 ASHTON CT
Second Line :
City : IMPERIAL
State : CA
Zip : 92251-8803
Country : US
Telephone Number : 760-455-3306
Fax Number :
Provider Business Practice Location Address
First Line : 120 W COLE BLVD
Second Line : SUITE B
City : CALEXICO
State : CA
Zip : 92231-9700
Country : US
Telephone Number : 760-357-7877
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ROMULO J GARCIA
Credential : PTA
Telephone Number : 760-455-3306
Provider Enumeration Date : 08/13/2007
Last Update Date : 08/13/2007

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Directions to “SOUTHWEST REHAB SPECIALIST ” Practice Location

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