Organization
KETAMINE CLINICS LLC
Active
Other names
Ketamine Clinics of Los Angeles
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL HERBERT MANDEL (CHIEF OPERATING OFFICER)
(310) 270-0625
Entity
Organization
Contact information
Practice address
6801 PARK TER STE 525, LOS ANGELES, CA 90045-1543
(310) 270-0625
Mailing address
6801 PARK TER STE 525, LOS ANGELES, CA 90045-1543
(310) 270-0625
(310) 730-5993
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
01/08/2019
Last updated
01/08/2019
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