Provider Demographics
NPI:1457019572
Name:PLASTIKOS INC.
Entity Type:Organization
Organization Name:PLASTIKOS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHGOZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-900-4532
Mailing Address - Street 1:30700 RUSSELL RANCH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-9507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30700 RUSSELL RANCH RD STE 250
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-9507
Practice Address - Country:US
Practice Address - Phone:818-900-4532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service