Provider Demographics
NPI:1568548279
Name:SOUTHERN CALIFORNIA SPORTS REHABILITATION, INC.
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SPORTS REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-975-1900
Mailing Address - Street 1:1809 E DYER RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5740
Mailing Address - Country:US
Mailing Address - Phone:949-863-0022
Mailing Address - Fax:949-863-0023
Practice Address - Street 1:1809 E DYER RD
Practice Address - Street 2:SUITE 313
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5740
Practice Address - Country:US
Practice Address - Phone:949-975-1900
Practice Address - Fax:949-975-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18280Medicare PIN