Provider Demographics
NPI:1639860620
Name:VALLEY REGENERATIVE AND PAIN CLINIC
Entity Type:Organization
Organization Name:VALLEY REGENERATIVE AND PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-995-4488
Mailing Address - Street 1:17000 VENTURA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4187
Mailing Address - Country:US
Mailing Address - Phone:818-995-4488
Mailing Address - Fax:
Practice Address - Street 1:17000 VENTURA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4187
Practice Address - Country:US
Practice Address - Phone:818-995-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty