Provider Demographics
NPI:1396868212
Name:HAND CENTER OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:HAND CENTER OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEROSE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:818-785-9515
Mailing Address - Street 1:7120 HAYVENHURST AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3813
Mailing Address - Country:US
Mailing Address - Phone:818-785-9515
Mailing Address - Fax:818-785-9535
Practice Address - Street 1:7120 HAYVENHURST AVE STE 215
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3813
Practice Address - Country:US
Practice Address - Phone:818-785-9515
Practice Address - Fax:818-785-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT950225XH1200X
CAOT512225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14837AOtherMEDICARE
CAW14837AOtherMEDICARE
CA4185810002Medicare NSC
CAWN380493AMedicare ID - Type UnspecifiedMEDICARE INDIV PROVIDER #
CA4185810001Medicare NSC
CAW14837AOtherMEDICARE
CA=========OtherCA TAX ID #