Healthsource Medical Network, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

HEALTHSOURCE MEDICAL NETWORK, INC.

Practice address

11190 Warner Ave Ste 302
Fountain Valley, CA 92708-4047

Phone

(714) 241-8000

Fax

(714) 241-8003

NPI assigned

Feb 12, 2014

Organization subpart

No

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

Authorized official

Name

Arnold Sanvicente

Title

President

Phone

(909) 971-9334

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392163200000",
    "number": "1366866246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 W ALLEN AVE STE 18",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917734709",
            "telephone_number": "909-971-9334",
            "fax_number": "909-575-3573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11190 WARNER AVE STE 302",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084047",
            "telephone_number": "714-241-8000",
            "fax_number": "714-241-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE MEDICAL NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-12",
        "last_updated": "2014-02-12",
        "status": "A",
        "authorized_official_last_name": "SANVICENTE",
        "authorized_official_first_name": "ARNOLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-971-9334"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2014; 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.