Provider Demographics
NPI:1265629752
Name:SOUTHERN CALIFORNIA CORF
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA CORF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPELEKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-700-0478
Mailing Address - Street 1:11024 BALBOA BLVD.
Mailing Address - Street 2:504
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-700-0478
Mailing Address - Fax:818-700-0475
Practice Address - Street 1:18531 ROSCOE BLVD.
Practice Address - Street 2:215
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-700-0478
Practice Address - Fax:818-975-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
CADC 27178111N00000X
CADC27178111N00000X
CAPT28631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty