Provider Demographics
NPI:1790722056
Name:TAYEBI, HOSSEIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:TAYEBI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 SAN BERNARDINO AVE
Mailing Address - Street 2:SUITE # B3
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3559
Mailing Address - Country:US
Mailing Address - Phone:909-447-6600
Mailing Address - Fax:909-447-6601
Practice Address - Street 1:1532 SAN BERNARDINO AVE
Practice Address - Street 2:SUITE B3
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3559
Practice Address - Country:US
Practice Address - Phone:909-447-6600
Practice Address - Fax:909-447-6601
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30221174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT30221Medicare UPIN