Basic Information
| Provider Information | |||||||||
| NPI: | 1467799742 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN AND HEALING INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1964 WESTWOOD BLVD | ||||||||
| Address2: | SUITE 435 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900254651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108569488 | ||||||||
| FaxNumber: | 3108176402 | ||||||||
| Practice Location | |||||||||
| Address1: | 1964 WESTWOOD BLVD | ||||||||
| Address2: | STE.#435 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900254695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109038878 | ||||||||
| FaxNumber: | 3108176402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2013 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | SAMIMI | ||||||||
| AuthorizedOfficialFirstName: | NADIV | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3108569488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.