Provider Demographics
NPI:1366684144
Name:ORIGINAL OSTEOPATHY
Entity Type:Organization
Organization Name:ORIGINAL OSTEOPATHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-765-4044
Mailing Address - Street 1:420 S BEVERLY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4426
Mailing Address - Country:US
Mailing Address - Phone:310-765-4044
Mailing Address - Fax:310-601-7700
Practice Address - Street 1:420 S BEVERLY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4426
Practice Address - Country:US
Practice Address - Phone:310-765-4044
Practice Address - Fax:310-601-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7955208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty