Provider Demographics
NPI:1316990963
Name:OPTIMAL REHAB, INC.
Entity type:Organization
Organization Name:OPTIMAL REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-394-0012
Mailing Address - Street 1:PO BOX 4586
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0821
Mailing Address - Country:US
Mailing Address - Phone:909-394-0012
Mailing Address - Fax:909-305-1636
Practice Address - Street 1:430 S CATARACT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2902
Practice Address - Country:US
Practice Address - Phone:909-394-0012
Practice Address - Fax:909-305-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMDR1803332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0857640001Medicare NSC