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General NPI Number Information
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NPI Number | 1023069804
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Entity Type | Organization
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Legal Business Name | SHALOM PAIN TRETAMENT MEDICAL CTR, INC.
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 9663 SANTA MONICA BLVD #683
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 310-601-7302
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Fax | 310-601-7276
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Provider Business Mailing Address
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Address Line | 9663 SANTA MONICA BLVD #683
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 310-601-7302
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Fax | 310-601-7276
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Authorized Official
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Title or Position | DIRECTOR
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Name | KOUROSH NOORMAND
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Credential | MD
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Telephone | 310-601-7302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A50982
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License Number State | CA
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