Healthcare Provider Details

I. General information

NPI: 1508816943
Provider Name (Legal Business Name): JAMES E BEDROSSIAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W MAIN ST
EL CENTRO CA
92243-2212
US

IV. Provider business mailing address

317 N. EL CAMINO REAL #210
ENCINITAS CA
92024-2813
US

V. Phone/Fax

Practice location:
  • Phone: 760-337-1144
  • Fax: 760-337-8259
Mailing address:
  • Phone: 760-337-1144
  • Fax: 760-337-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 28666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: