=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225984420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOOMAN M. JAVANMARDI PHYSICAL THERAPIST PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2026
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14001 NEWPORT AVE STE F
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-7830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-758-0097
-----------------------------------------------------
Fax | 951-934-0555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 5455
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92517-5455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-758-0097
-----------------------------------------------------
Fax | 951-934-0555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / OWNER
-----------------------------------------------------
Name | HOOMAN MEHDI JAVANMARDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-684-2865
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------