Provider Demographics
NPI:1225573793
Name:EOCCMED.COM
Entity Type:Organization
Organization Name:EOCCMED.COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-721-6162
Mailing Address - Street 1:15332 ANTIOCH ST # 823
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3628
Mailing Address - Country:US
Mailing Address - Phone:310-804-2720
Mailing Address - Fax:310-804-3956
Practice Address - Street 1:15332 ANTIOCH ST # 823
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3628
Practice Address - Country:US
Practice Address - Phone:310-804-2720
Practice Address - Fax:310-804-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0557272081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty