NPIMap

Organization Active NPI

Optc Westside Inc

  • Physical Therapist
  • Culver City, CA
National Provider Identifier
1942209242
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OPTC WESTSIDE INC
Practice address
3831 Hughes Ave
Ste 104
Culver City, CA 90232-2751
Phone
(310) 837-9700
Fax
(310) 837-9701
NPI assigned
Jul 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Cristina Carmen GaborNPI 1467533935
Title
President
Phone
(310) 837-9700

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: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3831 Hughes Ave
Ste 104
Culver City, CA 90232-2751

Mailing address

3831 Hughes Ave
Ste 104
Culver City, CA 90232-2751
Phone (310) 837-9700

Other names 1

  • Orthosport Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050302001085 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1355394214 Receives reassigned benefits from 15 practitioners
Practice locations: Culver City, CA

National Provider Directory

National Provider Directory
Tax ID family
Optc Westside Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10190 Culver Blvd
Culver City, CA 90232
Phone (310) 837-9700

3831 Hughes Ave
Ste 104
Culver City, CA 90232
Phone (310) 837-9700

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942209242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE",
            "address_2": "STE 104",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322751",
            "telephone_number": "310-837-9700",
            "fax_number": "310-837-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE",
            "address_2": "STE 104",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322751",
            "telephone_number": "310-837-9700",
            "fax_number": "310-837-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTC WESTSIDE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GABOR",
        "authorized_official_first_name": "CRISTINA",
        "authorized_official_middle_name": "CARMEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-837-9700"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthosport Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.