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General NPI Number Information
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NPI Number | 1487132338
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Entity Type | Organization
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Legal Business Name | ELITE CALIFORNIA PAIN AND SPINE INSTITUTE
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 11271 VENTURA BLVD SUITE 472
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City | STUDIO CITY
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State | CA
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Zip | 91604-3136
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Country | US
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Telephone | 310-254-6519
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Fax |
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Provider Business Mailing Address
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Address Line | 11271 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-3136
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Country | US
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Telephone | 310-254-6519
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/DIRECTOR
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Name | BAHMAN SHAMLOO
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Credential | MD
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Telephone | 310-254-6519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | 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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A103444
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License Number State | CA
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