| Corona Del Mar Rehab, Inc | |
|
1441 Avocado Ave Ste 307 Newport Beach CA 92660-7704 | |
| (949) 640-2121 | |
| (949) 640-2631 |
| Full Name | Corona Del Mar Rehab, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1441 Avocado Ave Ste 307, Newport Beach, California |
| Authorized Official Name and Position | Brian R Fracalosy (H.R. MANAGER) |
| Authorized Official Contact | 9496402121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corona Del Mar Rehab, Inc 1441 Avocado Ave Ste 307 Newport Beach CA 92660-7704 Ph: (949) 640-2121 | Corona Del Mar Rehab, Inc 1441 Avocado Ave Ste 307 Newport Beach CA 92660-7704 Ph: (949) 640-2121 |
| NPI Number | 1164466785 |
|---|---|
| Provider Enumeration Date | 06/15/2006 |
| Last Update Date | 10/07/2022 |
| Medicare PECOS PAC ID | 4688686538 |
|---|---|
| Medicare Enrollment ID | O20060615000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164466785 | NPI | - | NPPES |
| W19811 | Other | CA | MEDICARE, PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | BT00015281 (California) | Primary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Secondary |
| Provider Name | Joanne W Mimm |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407929995 PECOS PAC ID: 5092798587 Enrollment ID: I20040607001468 |
| Provider Name | Christie A Torti |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1962404988 PECOS PAC ID: 2860440658 Enrollment ID: I20050107000926 |
| Provider Name | Kern Hansen Haug |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1619929056 PECOS PAC ID: 6204848153 Enrollment ID: I20060615000193 |
| Provider Name | Victoria A Adams |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760418537 PECOS PAC ID: 6507879475 Enrollment ID: I20060718000205 |
| Provider Name | Alisa S Sanchez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194845446 PECOS PAC ID: 5597862888 Enrollment ID: I20070522000159 |
| Provider Name | Miki Bernal |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558443572 PECOS PAC ID: 9335219021 Enrollment ID: I20080606000712 |
| Provider Name | Heather M Ritchie |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164698239 PECOS PAC ID: 2163558834 Enrollment ID: I20100507000330 |
| Provider Name | Nicole C Reaves |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1235544354 PECOS PAC ID: 5395964100 Enrollment ID: I20140909002832 |
| Provider Name | Mary P Crompton |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1215353156 PECOS PAC ID: 5092091348 Enrollment ID: I20170420002754 |
| Provider Name | Jeffrey L Fracalosy |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1245789080 PECOS PAC ID: 2567365281 Enrollment ID: I20171213000386 |
| Provider Name | Brandon D Cirbo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154800050 PECOS PAC ID: 1254684319 Enrollment ID: I20181019001754 |
| Provider Name | Kathleen H Fiorenza |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265082424 PECOS PAC ID: 1658603907 Enrollment ID: I20191106000468 |
| Provider Name | Melissa M Magdangal |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467077016 PECOS PAC ID: 4688078892 Enrollment ID: I20210810004017 |
| Provider Name | Michael B Fernandez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679229876 PECOS PAC ID: 5890181341 Enrollment ID: I20220408001366 |
| Provider Name | Cameron J Webb |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1306532478 PECOS PAC ID: 0941655427 Enrollment ID: I20240123004745 |
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