Ativa Physical Medicine PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

ATIVA PHYSICAL MEDICINE PC

Practice address

4950 Hamilton Ave Ste 109
San Jose, CA 95130-1748

Phone

(408) 256-3865

Fax

(408) 883-8171

NPI assigned

Mar 16, 2022

Last updated

Mar 16, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tam Ly, DCNPI 1720026842

Title

Clinic Director

Phone

(408) 256-3865

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tam Van Ly, D.C

  • Chiropractor
  • San Jose, CA
  • NPI 1720026842
  Authorized official Same address or phone
• Nina Metanat

  • Registered Nurse
  • Fremont, CA
  • NPI 1265739205
  NPD
• Armen Derian, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Mesa, AZ
  • NPI 1275978876
  NPD (past)

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

{
    "created_epoch": "1647388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1760130827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 HAMILTON AVE STE 109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951301748",
            "telephone_number": "408-256-3865",
            "fax_number": "408-883-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 HAMILTON AVE STE 109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951301748",
            "telephone_number": "408-256-3865",
            "fax_number": "408-883-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATIVA PHYSICAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-16",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "LY",
        "authorized_official_first_name": "TAM",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "408-256-3865",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Atienza
• Jennifer Garma Atienza, MD
• Robert Gonzales Atienza, MD
• Brianna Atiock
• Shreya Atitkar, DO
• Sharyn Atkin, LPT
• Estella Atkins
• Kyle William Atkins
• Dawn Atkinson
• Love Atkinson

• Physical Medicine & Rehabilitation Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.