Healthcare Provider Details

I. General information

NPI: 1699198713
Provider Name (Legal Business Name): ADVENT PHYSICAL THERAPY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 PEARL ST 108
LA JOLLA CA
92037-0056
US

IV. Provider business mailing address

737 PEARL ST 108
LA JOLLA CA
92037-0056
US

V. Phone/Fax

Practice location:
  • Phone: 858-456-2114
  • Fax: 858-456-2103
Mailing address:
  • Phone: 858-456-2114
  • Fax: 858-456-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE EDUARDO SARMIENTO
Title or Position: VICE-PRESIDENT
Credential: PT
Phone: 858-456-2114