Provider Demographics
NPI:1508338765
Name:GHOMRI HEALTH CARE INC
Entity Type:Organization
Organization Name:GHOMRI HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOMRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-971-4757
Mailing Address - Street 1:1100 E BROADWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1380
Mailing Address - Country:US
Mailing Address - Phone:310-971-4757
Mailing Address - Fax:855-795-4464
Practice Address - Street 1:1100 E BROADWAY STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1380
Practice Address - Country:US
Practice Address - Phone:310-971-4757
Practice Address - Fax:855-795-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty