Provider Demographics
NPI:1295570554
Name:KELEVATE LIFE PC
Entity type:Organization
Organization Name:KELEVATE LIFE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIRAK
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-650-9883
Mailing Address - Street 1:7901 SANTA MONICA BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5180
Mailing Address - Country:US
Mailing Address - Phone:323-650-9883
Mailing Address - Fax:323-402-5841
Practice Address - Street 1:7901 SANTA MONICA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5180
Practice Address - Country:US
Practice Address - Phone:323-650-9883
Practice Address - Fax:323-402-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty