Healthcare Provider Details

I. General information

NPI: 1790183648
Provider Name (Legal Business Name): DOCTOR JOSEPH ENAYATI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD STE 100
LOS ANGELES CA
90035-1630
US

IV. Provider business mailing address

822 S ROBERTSON BLVD STE 100
LOS ANGELES CA
90035-1630
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-6937
  • Fax: 310-388-0185
Mailing address:
  • Phone: 310-651-6937
  • Fax: 310-388-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH ENAYATI
Title or Position: ATTENDING/CEO
Credential: DO
Phone: 310-651-6937