Provider Demographics
NPI:1750489274
Name:SOUTHERN CALIFORNIA MOBILITY, INC.
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA MOBILITY, INC.
Other - Org Name:REHABNET OUTPATIENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DE COU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-596-9400
Mailing Address - Street 1:18368 ENTERPRISE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1201
Mailing Address - Country:US
Mailing Address - Phone:714-596-9400
Mailing Address - Fax:714-596-9500
Practice Address - Street 1:1260 15TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1135
Practice Address - Country:US
Practice Address - Phone:310-451-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26142225100000X
CA29608225100000X
CA27278225100000X
CA10329225100000X
CA27292225100000X
CA23946225100000X
CA5715225X00000X
CA4602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4968070001Medicare NSC
CAW16429Medicare UPIN
CADB4684Medicare PIN