Provider Demographics
NPI:1447205828
Name:SOUTH PACIFIC REHABILITATION SERVICES, INC
Entity Type:Organization
Organization Name:SOUTH PACIFIC REHABILITATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IYOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-986-1977
Mailing Address - Street 1:16260 VENTURA BLVD, STE 600
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4604
Mailing Address - Country:US
Mailing Address - Phone:818-976-1977
Mailing Address - Fax:818-986-4757
Practice Address - Street 1:44303 LOWTREE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4149
Practice Address - Country:US
Practice Address - Phone:661-940-5494
Practice Address - Fax:661-940-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14538Medicare PIN