Provider Demographics
NPI:1417372111
Name:NATIVIDAD MEDICAL CENTER REHABILITATION
Entity Type:Organization
Organization Name:NATIVIDAD MEDICAL CENTER REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-755-4185
Mailing Address - Street 1:P.O. BOX 80007
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93912-3195
Mailing Address - Country:US
Mailing Address - Phone:831-755-4111
Mailing Address - Fax:831-755-4087
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-755-4242
Practice Address - Fax:831-755-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699979245Medicaid
CA1174727143Medicaid
CA1699979245Medicaid
CA05T248Medicare UPIN