Tavarua Medical Rehabilitation Services

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

19-126 Issued in CA

Legal business name

TAVARUA MEDICAL REHABILITATION SERVICES

Doing business as

Azusa Medical and Mental Health Services

Practice address

474 S Citrus Ave
Azusa, CA 91702-4733

Phone

(626) 858-9500

Fax

(626) 858-9090

NPI assigned

Mar 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cynthia Ann Blanks

Title

Executive Director

Phone

(661) 254-6630

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• AZUSA MEDICAL AND MENTAL HEALTH SERVICES Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Tax ID family

Azusa Medical and Mental Health Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Tavarua Medical Rehabilitation Services

  dba Tavarua Medical & Mental Services

  • Primary Care Clinic/Center
  • Lawndale, CA
  • NPI 1609135771
  NPD tax ID
• Tavarua Medical Rehabilitation Services

  dba Tavarua Medical & Mental Services

  • Primary Care Clinic/Center
  • Van Nuys, CA
  • NPI 1679832745
  NPD tax ID
• Tavarua Medical Rehabilitation Services

  dba Azusa Medical and Mental Health Services

  • Methadone Clinic
  • Azusa, CA
  • NPI 1679848568
  NPD tax ID
• Tavarua Medical Rehabilitation Services

  dba Tavarua Mediacl & Mental Services

  • Primary Care Clinic/Center
  • Hawaiian Gardens, CA
  • NPI 1972862043
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Yadegari, M.D

  • Gastroenterology Physician
  • Van Nuys, CA
  • NPI 1023293016
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761868800000",
    "number": "1184990814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26460 SUMMIT CIR",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913502991",
            "telephone_number": "661-254-6630",
            "fax_number": "661-254-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 S CITRUS AVE",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917024733",
            "telephone_number": "626-858-9500",
            "fax_number": "626-858-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAVARUA MEDICAL REHABILITATION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-27",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A",
        "authorized_official_last_name": "BLANKS",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "661-254-6630"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "19-126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19CQ",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE NTP LICENSE",
            "identifier": "19-126",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AZUSA MEDICAL AND MENTAL HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Suffolk Home Health, Inc
• Sheela Surapaneni, M.D.
• Riplee Marie Tafoya
• Linda Weiching Tang-Lin, PHARMD
• Roderic J Tate
• Tavarua Medical Rehabilitation Services (Azusa Medical and Mental Health Services)
• Tavarua Rehabilitation Services
• Larry James Taylor II, OTR/L
• Nicholas Taylor
• Gabriela R Teresa, LMFT

• Substance Use Disorder Rehabilitation Clinic/Center in Azusa, CA
• Providers in Azusa, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.