1285274035 NPI number — IN-LINE MEDICAL, INC., A PROFESSIONAL MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285274035 NPI number — IN-LINE MEDICAL, INC., A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN-LINE MEDICAL, INC., A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285274035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16350 VENTURA BLVD # D569
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-217-1301
Provider Business Mailing Address Fax Number:
424-217-1302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 WILSHIRE BLVD STE 510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-217-1301
Provider Business Practice Location Address Fax Number:
424-217-1302
Provider Enumeration Date:
01/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GRAVORI
Authorized Official First Name:
TOORAJ
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
310-278-7000

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com