Basic Information
| Provider Information | |||||||||
| NPI: | 1386844017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED HEALTHCARE REGISTRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1738 SPRUCE ST | ||||||||
| Address2: | APT. C | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947091758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158234641 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4655 RUFFNER ST | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921112275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007876787 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2007 | ||||||||
| LastUpdateDate: | 03/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCHREVE | ||||||||
| AuthorizedOfficialFirstName: | KAY | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4158234641 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 1891 | CA | N | Hospitals | Long Term Care Hospital | 282N00000X | 1891 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.