Provider Demographics
NPI:1689049785
Name:TWINS PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:TWINS PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-985-9554
Mailing Address - Street 1:13311 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2202
Mailing Address - Country:US
Mailing Address - Phone:714-621-0327
Mailing Address - Fax:714-621-0601
Practice Address - Street 1:13311 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2202
Practice Address - Country:US
Practice Address - Phone:714-621-0327
Practice Address - Fax:714-621-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6613305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization