Healthcare Provider Details

I. General information

NPI: 1902825045
Provider Name (Legal Business Name): AVROM GART, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EUCALYPTUS DR
EL SEGUNDO CA
90245-3839
US

IV. Provider business mailing address

444 S SAN VICENTE BLVD SUITE 800
LOS ANGELES CA
90048-4165
US

V. Phone/Fax

Practice location:
  • Phone: 310-322-4278
  • Fax:
Mailing address:
  • Phone: 310-423-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AVROM GART
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-423-9900