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General NPI Number Information
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NPI Number | 1497119960
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Entity Type | Individual
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Provider Name | SIAVASH BOLOURANI
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Gender | Male
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2121 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-2303
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Country | US
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Telephone | 310-315-6125
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Fax | 310-582-7185
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Provider Business Mailing Address
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Address Line | 2121 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-2303
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Country | US
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Telephone | 310-315-6125
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Fax | 310-582-7185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 000000000000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A193634
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License Number State | CA
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