| Life Well Institute | |
|
5835 Washington Blvd, Culver City, CA 90232-7330 | |
| (323) 857-0800 | |
| (323) 939-7951 |
| Full Name | Life Well Institute |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 5835 Washington Blvd, Culver City, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255486866 | NPI | - | NPPES |
| 00A401680 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | A40168 (California) | Primary |
| Provider Name | Shahram Ravan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1073544417 PECOS PAC ID: 9830158203 Enrollment ID: I20120405000187 |
| Mailing Address | Practice Location Address |
|---|---|
| Life Well Institute 436 N Bedford Dr, Suite 214, Beverly Hills, CA 90210-4310 Ph: (310) 858-9200 | Life Well Institute 5835 Washington Blvd, Culver City, CA 90232-7330 Ph: (323) 857-0800 |
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