Provider Demographics
NPI:1457781189
Name:SILVA SPORTS MEDICINE & REHAB
Entity Type:Organization
Organization Name:SILVA SPORTS MEDICINE & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:310-372-8551
Mailing Address - Street 1:1200 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3955
Mailing Address - Country:US
Mailing Address - Phone:310-372-8551
Mailing Address - Fax:310-372-8945
Practice Address - Street 1:1200 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3955
Practice Address - Country:US
Practice Address - Phone:310-372-8551
Practice Address - Fax:310-372-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21802111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty