Provider Demographics
NPI:1295974103
Name:ERGOSPEC, INC
Entity type:Organization
Organization Name:ERGOSPEC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN MAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-484-0967
Mailing Address - Street 1:10417 SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4232
Mailing Address - Country:US
Mailing Address - Phone:714-484-0967
Mailing Address - Fax:
Practice Address - Street 1:2020 E IMPERIAL HWY
Practice Address - Street 2:BLDG. S25
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3507
Practice Address - Country:US
Practice Address - Phone:310-662-5590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty