Organization
LAGUNA BEACH REHAB, INC.
Active
Organization
LAGUNA BEACH REHAB, INC.
Active
Other names
Corona del Mar Rehab, Inc., Corona del Mar Rehab, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN R FRACALOSY (H.R. MANAGER)
(949) 640-2121
Entity
Organization
Contact information
Practice address
1441 AVOCADO AVE STE 307, NEWPORT BEACH, CA 92660-7704
(949) 640-2121
(949) 640-2631
Mailing address
1441 AVOCADO AVE STE 307, NEWPORT BEACH, CA 92660-7704
(949) 640-2121
(949) 640-2631
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
BT00015281
CA
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W19811
MEDICARE, PTAN
CA
Enumeration date
06/15/2006
Last updated
10/07/2022
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