Provider Demographics
NPI:1346888476
Name:SEBASTIAN, GASPAR PASCUAL (DPT)
Entity Type:Individual
Prefix:
First Name:GASPAR
Middle Name:PASCUAL
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 HARTFORD AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4012
Mailing Address - Country:US
Mailing Address - Phone:213-949-2489
Mailing Address - Fax:
Practice Address - Street 1:5450 W PICO BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3997
Practice Address - Country:US
Practice Address - Phone:818-894-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist