# LA SPINE INTERVENTION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518362144
- **Authorized official:** EVISH KAMRAVA MD (PRESIDENT)
- **Authorized official phone:** (310) 828-7757

## Contact information

- **Practice address:** 2811 WILSHIRE BLVD, SUITE 850, SANTA MONICA, CA 90403-4803
- **Practice address phone:** (310) 828-7757
- **Practice address fax:** (310) 594-8924
- **Mailing address:** PO BOX 3129, TORRANCE, CA 90510-3129
- **Mailing address phone:** (310) 792-3914
- **Mailing address fax:** (855) 898-4055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/24/2014
- **Last updated:** 10/17/2022