Provider Demographics
NPI:1023069804
Name:SHALOM PAIN TRETAMENT MEDICAL CTR, INC.
Entity type:Organization
Organization Name:SHALOM PAIN TRETAMENT MEDICAL CTR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-601-7302
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:#683
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-601-7302
Mailing Address - Fax:310-601-7276
Practice Address - Street 1:9663 SANTA MONICA BLVD
Practice Address - Street 2:#683
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4303
Practice Address - Country:US
Practice Address - Phone:310-601-7302
Practice Address - Fax:310-601-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty