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General NPI Number Information
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NPI Number | 1497615686
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Entity Type | Organization
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Legal Business Name | THRIVE HEALTH IV CLINIC PC
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 4849 VAN NUYS BLVD STE 202A
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2110
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Country | US
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Telephone | 310-363-8757
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Fax | 310-363-8758
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Provider Business Mailing Address
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Address Line | 9675 BRIGHTON WAY STE 410
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5192
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Country | US
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Telephone | 310-363-8757
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Fax | 310-363-8758
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAYMOND S DOUGLAS
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Credential | MD, PHD
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Telephone | 310-657-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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