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General NPI Number Information
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NPI Number | 1194378471
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Entity Type | Organization
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Legal Business Name | LOTUS JOINT & SPINE INC
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 16550 VENTURA BLVD STE 400
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City | ENCINO
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State | CA
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Zip | 91436-2040
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Country | US
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Telephone | 818-307-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 16550 VENTURA BLVD STE 400
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City | ENCINO
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State | CA
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Zip | 91436-2040
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Country | US
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Telephone | 818-307-6508
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PRESIDENT
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Name | DR. RAMIN SHAMTOB
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Credential | MD
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Telephone | 818-307-6508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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