Performance Rehab Wellness Center

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PERFORMANCE REHAB WELLNESS CENTER

Practice address

12389 San Ysidro St
Victorville, CA 92392-6623

Phone

(760) 490-4524

Fax

(760) 927-3268

NPI assigned

Jun 19, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Hazel Nikki Mangaoang David

Title

Partner

Phone

(760) 490-4524

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1902210644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12389 SAN YSIDRO ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923926623",
            "telephone_number": "760-490-4524",
            "fax_number": "760-927-3268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12389 SAN YSIDRO ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923926623",
            "telephone_number": "760-490-4524",
            "fax_number": "760-927-3268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE REHAB WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-19",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "DAVID",
        "authorized_official_first_name": "HAZEL NIKKI",
        "authorized_official_middle_name": "MANGAOANG",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "760-490-4524",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rayna Perez
• Reyna Esmeralda Perez
• Sarah Meyney Perez
• Vannesza D Perez
• Victoria Lynn Perez
• Richard Paul Perry, CHIROPRACTOR
• Tina Dyane Perry
• Velia Person
• Leonard Joseph Petitti, D.D.S.
• Sari Petrus, LVN

• Physical Therapy Clinic/Center in Victorville, CA
• Providers in Victorville, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.