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General NPI Number Information
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NPI Number | 1275988040
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Entity Type | Organization
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Legal Business Name | AVANTI SPORTS MEDICINE & FITNESS
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 175 N REDWOOD DR SUITE 275
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1972
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Country | US
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Telephone | 800-704-0028
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Fax |
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Provider Business Mailing Address
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Address Line | 219 BRANNAN ST SUITE A
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-4030
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Country | US
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Telephone | 415-363-0466
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Fax | 415-859-9265
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SONIA D BELL
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Credential | MD
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Telephone | 415-363-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A85402
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License Number State | CA
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