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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