Provider Demographics
NPI:1679508220
Name:ACE CONSULTING GROUP
Entity Type:Organization
Organization Name:ACE CONSULTING GROUP
Other - Org Name:SELECTIVE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:949-475-1002
Mailing Address - Street 1:4341 BIRCH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1924
Mailing Address - Country:US
Mailing Address - Phone:949-475-1002
Mailing Address - Fax:949-475-1003
Practice Address - Street 1:4341 BIRCH ST
Practice Address - Street 2:STE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1924
Practice Address - Country:US
Practice Address - Phone:949-475-1002
Practice Address - Fax:949-475-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty