Provider Demographics
NPI:1750061149
Name:ARC-LINE MEDICAL , INC.
Entity type:Organization
Organization Name:ARC-LINE MEDICAL , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVORI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-620-2727
Mailing Address - Street 1:9662 SANTA MONICA BLVD
Mailing Address - Street 2:#882
Mailing Address - City:BEVERLY HILS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-620-2727
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3906
Practice Address - Country:US
Practice Address - Phone:310-620-2727
Practice Address - Fax:310-620-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty