Organization
COMPLEX REHAB SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GARY HAUSER (PRESIDENT)
(866) 597-0609
Entity
Organization
Contact information
Practice address
251 IMPERIAL HWY STE 470, FULLERTON, CA 92835-1063
(866) 597-0609
(866) 597-0609
Mailing address
1215 W IMPERIAL HWY STE 101B, BREA, CA 92821-3738
(866) 597-0609
(866) 597-0609
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
ATP1528
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SRRC103216572
RESALE CERTIFICATE
CA
Enumeration date
02/23/2018
Last updated
10/17/2023
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