Organization
PERFORMANCE REHAB WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HAZEL NIKKI MANGAOANG DAVID (PARTNER)
(760) 490-4524
Entity
Organization
Contact information
Practice address
12389 SAN YSIDRO ST, VICTORVILLE, CA 92392-6623
(760) 490-4524
(760) 927-3268
Mailing address
12389 SAN YSIDRO ST, VICTORVILLE, CA 92392-6623
(760) 490-4524
(760) 927-3268
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
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