Healthcare Provider Details

I. General information

NPI: 1306439104
Provider Name (Legal Business Name): SYNERGEX MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S HEWITT ST UNIT B
LOS ANGELES CA
90013-2215
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 562-414-4452
  • Fax: 562-381-8130
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HIRSH KAVEESHVAR
Title or Position: PARTNER
Credential: DO
Phone: 562-414-4452