Provider Demographics
NPI:1679730923
Name:TOTAL REHABILITATION MEDICINE INC
Entity Type:Organization
Organization Name:TOTAL REHABILITATION MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIASGHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-547-9870
Mailing Address - Street 1:1407 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2416
Mailing Address - Country:US
Mailing Address - Phone:818-547-9870
Mailing Address - Fax:818-547-9870
Practice Address - Street 1:5635 CAHUENGA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2104
Practice Address - Country:US
Practice Address - Phone:818-308-7450
Practice Address - Fax:818-308-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97751208100000X
CAPT 12456225100000X
CAMTA44130291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679730923OtherMEDI-CAL