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NPI Code Detail

MEDICARE: DALLAS VERNON

MEDICARE: DALLAS VERNON
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1497997639
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALLAS VERNON
Provider Business Mailing Address
First Line : 7135 ISLAND VILLAGE DR
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-4306
Country : US
Telephone Number : 562-714-0406
Fax Number :
Provider Business Practice Location Address
First Line : 6055 E WASHINGTON BLVD
Second Line : SUITE 900
City : COMMERCE
State : CA
Zip : 90040-2449
Country : US
Telephone Number : 323-346-0960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2009
Last Update Date : 04/02/2009

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Directions to “ DALLAS VERNON ” Practice Location

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