# KETAMINE CLINICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ketamine Clinics of Los Angeles
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154894616
- **Authorized official:** SAMUEL HERBERT MANDEL (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (310) 270-0625

## Contact information

- **Practice address:** 6801 PARK TER STE 525, LOS ANGELES, CA 90045-1543
- **Practice address phone:** (310) 270-0625
- **Mailing address:** 6801 PARK TER STE 525, LOS ANGELES, CA 90045-1543
- **Mailing address phone:** (310) 270-0625
- **Mailing address fax:** (310) 730-5993

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/08/2019
- **Last updated:** 01/08/2019