Provider Demographics
NPI:1184746927
Name:GATEWAY REHAB & WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:GATEWAY REHAB & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RAFA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-454-8811
Mailing Address - Street 1:24002 VIA FABRICANTE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3901
Mailing Address - Country:US
Mailing Address - Phone:949-454-8811
Mailing Address - Fax:949-454-8833
Practice Address - Street 1:24002 VIA FABRICANTE
Practice Address - Street 2:SUITE 501
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3901
Practice Address - Country:US
Practice Address - Phone:949-454-8811
Practice Address - Fax:949-454-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-28755111N00000X
CADC-28726111N00000X
CAG060299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty