Healthcare Provider Details

I. General information

NPI: 1447740493
Provider Name (Legal Business Name): VARICOSE RELIEF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 W OLYMPIC BLVD SUITE 360
LOS ANGELES CA
90006-2484
US

IV. Provider business mailing address

3130 W OLYMPIC BLVD SUITE 360
LOS ANGELES CA
90006-2484
US

V. Phone/Fax

Practice location:
  • Phone: 323-733-1004
  • Fax: 323-733-1003
Mailing address:
  • Phone: 323-733-1004
  • Fax: 323-733-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberG86162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG86162
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG86162
License Number StateCA

VIII. Authorized Official

Name: MR. HOSSEIN BABAALI
Title or Position: M.D./CEO
Credential: M.D.
Phone: 310-367-3268