NPIMap

Organization Active NPI

Southside Physical Therapy and Sports Center

  • Physical Therapist
  • Huntington Beach, CA
National Provider Identifier
1174891980
Registry record updated Dec 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT26966 Issued in CA
Legal business name
SOUTHSIDE PHYSICAL THERAPY AND SPORTS CENTER
Practice address
22311 Brookhurst St Ste 104
Huntington Beach, CA 92646-8458
Phone
(714) 965-2222
Fax
(714) 965-2224
NPI assigned
Dec 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Victor Ramon Carlos, DPTNPI 1952362964
Title
President
Phone
(714) 965-2222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT26966 CA Primary

Addresses

Primary practice location

22311 Brookhurst St Ste 104
Huntington Beach, CA 92646-8458

Mailing address

22311 Brookhurst St Ste 104
Huntington Beach, CA 92646-8458
Phone (714) 965-2222

National Provider Directory

National Provider Directory

Locations

22311 Brookhurst St
Ste 104
Huntington Beach, CA 92646
Phone (714) 594-3690

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1174891980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22311 BROOKHURST ST STE 104",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926468458",
            "telephone_number": "714-965-2222",
            "fax_number": "714-965-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22311 BROOKHURST ST STE 104",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926468458",
            "telephone_number": "714-965-2222",
            "fax_number": "714-965-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PHYSICAL THERAPY AND SPORTS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-07",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "CARLOS",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "RAMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-965-2222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT26966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.