Provider Demographics
NPI:1598193294
Name:PACIFIC COAST INSTITUTE REHAB AND PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:PACIFIC COAST INSTITUTE REHAB AND PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CAO
Authorized Official - Last Name:NINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-432-9990
Mailing Address - Street 1:11190 WARNER AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4019
Mailing Address - Country:US
Mailing Address - Phone:714-432-9990
Mailing Address - Fax:714-432-9988
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4019
Practice Address - Country:US
Practice Address - Phone:714-432-9990
Practice Address - Fax:714-432-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98528261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy