Buenaventura Gaviola Agraviador III, PTLA
NPI 1366116170ActiveIndividual· Physical Therapist· Northridge, CA
Physical Therapist (PTLA) with Sansum Clinic, practicing in Northridge, California. Medicare paid $3,753 for services to 18 patients in 2024.
Overview
| NPI | 1366116170 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PTLA |
| Sole proprietor | Yes |
| NPI issued | Aug 4, 2021 |
| Last updated in NPPES | Aug 4, 2023 |
| Certified by provider | Aug 4, 2023 |
| Reactivated | Aug 4, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | PTLA | CA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (CA) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 18 |
|---|---|
| Services billed | 157 across 6 procedure codes |
| Paid by Medicare | $3,753 |
Education and affiliations
| Graduation year | 2024 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Sansum ClinicSanta Barbara, CA · 320 clinicians
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