Active NPI
Andrew Joseph Pavlov, PT, DPT, CSCS
- Physical Therapist
- San Diego, CA
National Provider Identifier
1154847895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 293463
- Practice address
- 4635 Mission Gorge PL Ste B
San Diego, CA 92120-4145 - Phone
- (619) 501-9037
- Fax
- (619) 501-9038
- NPI assigned
- Aug 15, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 293463 | CA | Primary |
Addresses
Primary practice location
4635 Mission Gorge PL Ste B
San Diego, CA 92120-4145
Mailing address
1084 N. El Camino Real
B-351
Encinitas, CA 92024
Phone (760) 918-9200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 293463 | Other | CA | CA PT LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502755200000",
"number": "1154847895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1084 N. EL CAMINO REAL",
"address_2": "B-351",
"city": "ENCINITAS",
"state": "CA",
"postal_code": "92024",
"telephone_number": "760-918-9200",
"fax_number": "760-918-9203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4635 MISSION GORGE PL STE B",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921204145",
"telephone_number": "619-501-9037",
"fax_number": "619-501-9038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAVLOV",
"first_name": "ANDREW",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PT, DPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-15",
"last_updated": "2017-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "293463",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA PT LICENSE",
"identifier": "293463",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.