| 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 |
| Certification 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 | () | 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 | 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 | 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 | Panna Patel |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093105504 PECOS PAC ID: 3375895659 Enrollment ID: I20181015003088 |
| 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 | 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 James Webb |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1306532478 PECOS PAC ID: 0941655427 Enrollment ID: I20240123004745 |
| Provider Name | Jonathan Piazza |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1619763497 PECOS PAC ID: 3870011349 Enrollment ID: I20250519001215 |
| Provider Name | Amanda Karen Luu |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1275242893 PECOS PAC ID: 6901309178 Enrollment ID: I20250912001822 |
| Provider Name | Karen Crouch |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1043304520 PECOS PAC ID: 1355377979 Enrollment ID: I20250922001683 |
| Provider Name | Rachel Park |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1083119598 PECOS PAC ID: 7315313517 Enrollment ID: I20251227000623 |
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