Healthcare Provider Details

I. General information

NPI: 1487132338
Provider Name (Legal Business Name): ELITE CALIFORNIA PAIN & SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST # 815E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST # 815E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-246-2358
  • Fax: 424-285-8534
Mailing address:
  • Phone: 310-254-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA103444
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BAHMAN SHAMLOO
Title or Position: PHYSICIAN/DIRECTOR
Credential: MD
Phone: 310-254-6519