Healthcare Provider Details

I. General information

NPI: 1417584244
Provider Name (Legal Business Name): DRAGONFLY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SANTA MONICA BLVD STE 204
SANTA MONICA CA
90404-2639
US

IV. Provider business mailing address

3200 SANTA MONICA BLVD STE 204
SANTA MONICA CA
90404-2639
US

V. Phone/Fax

Practice location:
  • Phone: 310-896-5183
  • Fax: 844-399-5022
Mailing address:
  • Phone: 310-896-5183
  • Fax: 844-399-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RISHI KHATRI
Title or Position: CEO
Credential:
Phone: 310-571-5957