Healthcare Provider Details

I. General information

NPI: 1063084093
Provider Name (Legal Business Name): ABTIN ANVARI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7146 EDINGER AVE
HUNTINGTON BEACH CA
92647-3568
US

IV. Provider business mailing address

7146 EDINGER AVE
HUNTINGTON BEACH CA
92647-3568
US

V. Phone/Fax

Practice location:
  • Phone: 714-377-4314
  • Fax:
Mailing address:
  • Phone: 714-377-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT300341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: