Provider Demographics
NPI:1326121393
Name:GUSTAVO PARADIZ
Entity Type:Organization
Organization Name:GUSTAVO PARADIZ
Other - Org Name:SAN JOSE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-254-7722
Mailing Address - Street 1:125 N JACKSON AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1903
Mailing Address - Country:US
Mailing Address - Phone:408-254-7722
Mailing Address - Fax:408-254-7416
Practice Address - Street 1:125 N JACKSON AVE
Practice Address - Street 2:STE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1903
Practice Address - Country:US
Practice Address - Phone:408-254-7722
Practice Address - Fax:408-254-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12719261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR24563Medicare UPIN
CAZZZ03250ZMedicare ID - Type Unspecified