Healthcare Provider Details

I. General information

NPI: 1912368358
Provider Name (Legal Business Name): BVM THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2016
Last Update Date: 03/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11611 SAN VICENTE BLVD #GF1
LOS ANGELES CA
90049-5106
US

IV. Provider business mailing address

11611 SAN VICENTE BLVD #GF1
LOS ANGELES CA
90049-5106
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-0013
  • Fax: 310-207-2630
Mailing address:
  • Phone: 310-820-0013
  • Fax: 310-207-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberA92794
License Number StateCA

VIII. Authorized Official

Name: DR. RAPHAEL DARVISH
Title or Position: AUTHORIZED SIGNATORY
Credential: M.D.
Phone: 310-826-2555