Organization
FUNCTIONAL RESTORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOOSA HEIKALI M.D. (PRESIDENT/MEDICAL DIRECTOR)
(818) 708-6163
Entity
Organization
Contact information
Practice address
18065 VENTURA BLVD, ENCINO, CA 91316-3517
(818) 708-6163
(818) 708-6167
Mailing address
PO BOX 491149, LOS ANGELES, CA 90049-9149
(818) 708-6163
(818) 708-6167
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Enumeration date
09/21/2007
Last updated
10/04/2007
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