MEDICARE: OPTC WESTSIDE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1942209242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTC WESTSIDE INC

Provider Business Mailing Address
First Line	:	3831 HUGHES AVE
Second Line	:	STE 104
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2751
Country	:	US
Telephone Number	:	310-837-9700
Fax Number	:	310-837-9701

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE
Second Line	:	STE 104
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2751
Country	:	US
Telephone Number	:	310-837-9700
Fax Number	:	310-837-9701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CRISTINA CARMEN GABOR
Credential	:
Telephone Number	:	310-837-9700

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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Directions to “OPTC WESTSIDE INC ” Practice Location

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