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General NPI Number Information
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NPI Number | 1861593360
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL RESTORATION MEDICAL CENTER, INC,
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11411 BROOKSHIRE AVE SUITE 101
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City | DOWNEY
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State | CA
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Zip | 90241-5003
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Country | US
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Telephone | 562-869-9192
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Fax | 562-923-1609
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Provider Business Mailing Address
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Address Line | 9134 W OLYMPIC BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3540
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Country | US
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Telephone | 310-432-1000
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MOOSA HEIKALI
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Credential | M.D.
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Telephone | 310-432-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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