Provider Demographics
NPI:1336714294
Name:PACIFIC COAST REHABILITATION
Entity Type:Organization
Organization Name:PACIFIC COAST REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:422-776-1004
Mailing Address - Street 1:5319 UNIVERSITY DR # 136
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2965
Mailing Address - Country:US
Mailing Address - Phone:224-777-8034
Mailing Address - Fax:224-236-4900
Practice Address - Street 1:2181 CITRACADO PARKWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92563-2415
Practice Address - Country:US
Practice Address - Phone:422-776-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty