Provider Demographics
NPI:1740422765
Name:HAND CENTER OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:HAND CENTER OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-785-9515
Mailing Address - Street 1:7120 HAYVENHURST AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3813
Mailing Address - Country:US
Mailing Address - Phone:818-785-9515
Mailing Address - Fax:
Practice Address - Street 1:22110 ROSCOE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3845
Practice Address - Country:US
Practice Address - Phone:818-347-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAND CENTER OF SOUTHERN CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-06
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
225XH1200XOtherTAXONOMY CODE
CA4185810002Medicare NSC