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General NPI Number Information
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NPI Number | 1558235911
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Entity Type | Organization
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Legal Business Name | PURE SKIN RECOVERY
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 18653 VENTURA BLVD STE 218
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City | TARZANA
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State | CA
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Zip | 91356-4103
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Country | US
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Telephone | 305-791-3160
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Fax |
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Provider Business Mailing Address
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Address Line | 18653 VENTURA BLVD STE 218
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City | TARZANA
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State | CA
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Zip | 91356-4103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HOMAYOUN EGHBALI
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Credential |
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Telephone | 305-791-3160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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