Healthcare Provider Details

I. General information

NPI: 1487388500
Provider Name (Legal Business Name): EPIDAURUS MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 AVIATION BLVD UNIT 88100
LOS ANGELES CA
90009-3496
US

IV. Provider business mailing address

8821 AVIATION BLVD UNIT 88100
LOS ANGELES CA
90009-3496
US

V. Phone/Fax

Practice location:
  • Phone: 848-228-0612
  • Fax:
Mailing address:
  • Phone: 848-228-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJ DESAI
Title or Position: OWNER
Credential: MD
Phone: 424-301-7090