Provider Demographics
NPI:1093554735
Name:TEMECULA VALLEY COMPREHENSIVE CENTER
Entity type:Organization
Organization Name:TEMECULA VALLEY COMPREHENSIVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED VOCATIONAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-390-2780
Mailing Address - Street 1:40700 CALIFORNIA OAKS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5789
Mailing Address - Country:US
Mailing Address - Phone:951-894-5072
Mailing Address - Fax:951-894-7324
Practice Address - Street 1:40700 CALIFORNIA OAKS RD STE 202
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-894-5072
Practice Address - Fax:951-894-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)