Provider Demographics
NPI:1790183648
Name:DOCTOR JOSEPH ENAYATI, INC
Entity Type:Organization
Organization Name:DOCTOR JOSEPH ENAYATI, INC
Other - Org Name:BEVERLY HILLS ADVANCED PAIN AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTENDING/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-927-6621
Mailing Address - Street 1:822 S ROBERTSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1630
Mailing Address - Country:US
Mailing Address - Phone:310-651-6937
Mailing Address - Fax:310-388-0185
Practice Address - Street 1:822 S ROBERTSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1630
Practice Address - Country:US
Practice Address - Phone:310-651-6937
Practice Address - Fax:310-388-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty