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General NPI Number Information
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NPI Number | 1629438064
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Entity Type | Organization
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Legal Business Name | LASERMD PAIN RELIEF, INC.
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Dates
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Enumeration Date | 02/27/2016
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 2809 N SEPULVEDA BLVD
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2727
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Country | US
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Telephone | 213-550-5600
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Fax | 213-325-6425
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Provider Business Mailing Address
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Address Line | 578 WASHINGTON BLVD 1036
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5442
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Country | US
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Telephone | 213-550-5600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. HAROLD KRAFT
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Credential | M.D.
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Telephone | 213-550-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 136863
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License Number State | CA
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