Healthcare Provider Details

I. General information

NPI: 1164552279
Provider Name (Legal Business Name): AVROM GART MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

122 SHELDON ST
EL SEGUNDO CA
90245-3915
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9900
  • Fax: 310-423-9991
Mailing address:
  • Phone: 310-322-4278
  • Fax: 310-322-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG59372
License Number StateCA

VIII. Authorized Official

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