Provider Demographics
NPI:1215129366
Name:SOUTHWEST REHAB SPECIALIST
Entity type:Organization
Organization Name:SOUTHWEST REHAB SPECIALIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMULO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:760-455-3306
Mailing Address - Street 1:2300 ASHTON CT
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-8803
Mailing Address - Country:US
Mailing Address - Phone:760-455-3306
Mailing Address - Fax:
Practice Address - Street 1:120 W COLE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9700
Practice Address - Country:US
Practice Address - Phone:760-357-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty