Healthcare Provider Details

I. General information

NPI: 1245697440
Provider Name (Legal Business Name): PURE OCCUPATIONAL AND SPORTS MEDICINE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 S ROBERTSON BLVD STE 242
LOS ANGELES CA
90035-1403
US

IV. Provider business mailing address

1171 S ROBERTSON BLVD STE 242
LOS ANGELES CA
90035-1403
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-4321
  • Fax: 310-657-8728
Mailing address:
  • Phone: 626-765-4321
  • Fax: 310-657-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHRIAR JARCHI
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 626-765-4321