Provider Demographics
NPI:1679166623
Name:STEM CELL & PRP INSTITUTE OF LA GENERAL & MENS HEALTH PAIN & AEST
Entity type:Organization
Organization Name:STEM CELL & PRP INSTITUTE OF LA GENERAL & MENS HEALTH PAIN & AEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURPARVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-207-6334
Mailing Address - Street 1:8631 W 3RD ST # 545E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:323-207-6334
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST # 545E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:323-207-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487290409Medicaid
CA1457504136Medicaid