# FUNCTIONAL RESTORATION MEDICAL CENTER

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

## Provider details

- **NPI number:** 1578758645
- **Authorized official:** DR. MOOSSA HEIKALI M.D. (PRESIDENT/MEDICAL DIRECTOR)
- **Authorized official phone:** (818) 708-6163

## Contact information

- **Practice address:** 18065 VENTURA BLVD, ENCINO, CA 91316-3517
- **Practice address phone:** (818) 708-6163
- **Practice address fax:** (818) 708-6167
- **Mailing address:** PO BOX 491149, LOS ANGELES, CA 90049-9149
- **Mailing address phone:** (818) 708-6163
- **Mailing address fax:** (818) 708-6167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A405591 | CA | Yes |

## Other

- **Enumeration date:** 09/11/2007
- **Last updated:** 09/11/2007