Provider Demographics
NPI:1285274035
Name:IN-LINE MEDICAL, INC., A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:IN-LINE MEDICAL, INC., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:TOORAJ
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:GRAVORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-278-7000
Mailing Address - Street 1:16350 VENTURA BLVD # D569
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-5300
Mailing Address - Country:US
Mailing Address - Phone:424-217-1301
Mailing Address - Fax:424-217-1302
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:424-217-1301
Practice Address - Fax:424-217-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty