Provider Demographics
NPI:1962401398
Name:AIJ, INC
Entity type:Organization
Organization Name:AIJ, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-466-6077
Mailing Address - Street 1:8380 CENTER DR
Mailing Address - Street 2:# E
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2952
Mailing Address - Country:US
Mailing Address - Phone:619-466-6077
Mailing Address - Fax:619-466-6118
Practice Address - Street 1:8380 CENTER DR
Practice Address - Street 2:# E
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2952
Practice Address - Country:US
Practice Address - Phone:619-466-6077
Practice Address - Fax:619-466-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27486225100000X
CA228472278P1005X
261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64706ZOtherBLUE SHIELD OF CA
CA054536Medicare ID - Type Unspecified