Provider Demographics
NPI:1639860620
Name:VALLEY REGENERATIVE AND PAIN CLINIC
Entity type:Organization
Organization Name:VALLEY REGENERATIVE AND PAIN CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNOOSH
Authorized Official - Middle Name:BEHDAD
Authorized Official - Last Name:RAHAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-759-1559
Mailing Address - Street 1:5400 BALBOA BLVD STE 141
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5203
Mailing Address - Country:US
Mailing Address - Phone:310-759-1559
Mailing Address - Fax:310-759-1560
Practice Address - Street 1:5400 BALBOA BLVD STE 141
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5203
Practice Address - Country:US
Practice Address - Phone:310-759-1559
Practice Address - Fax:310-759-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty