Healthcare Provider Details

I. General information

NPI: 1407886583
Provider Name (Legal Business Name): AVROM GART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD #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: 310-423-9960
  • Fax:
Mailing address:
  • Phone: 310-335-6840
  • Fax:

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:
Title or Position:
Credential:
Phone: