Provider Demographics
NPI:1154649481
Name:SOUTHERN CALIFORNIA INJURY TREATMENT CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA INJURY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLECTOR / BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZARRARAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-275-4544
Mailing Address - Street 1:14365 PIPELINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5642
Mailing Address - Country:US
Mailing Address - Phone:909-364-8111
Mailing Address - Fax:
Practice Address - Street 1:14365 PIPELINE AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5642
Practice Address - Country:US
Practice Address - Phone:909-364-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41089111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty