Organization
ELECTRO DIAGNOSTIC MEDICINE
Active
Organization
ELECTRO DIAGNOSTIC MEDICINE
Active
Parent organization
TOTAL REHABILITATION MEDICINE INC
Other names
EMG&NCV practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
TOTAL REHABILITATION MEDICINE INC
Authorized official
DR. ALIASGHAR MATIN MD (PROVIDER)
(818) 308-7450
Entity
Organization
Contact information
Practice address
5635 CAHUENGA BLVD, NORTH HOLLYWOOD, CA 91601-2104
(818) 308-7450
Mailing address
1407 HILLSIDE DR, GLENDALE, CA 91208-2416
(818) 547-9870
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
A97751
CA
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
A97751
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
A97751
CA
261QP2000X
Physical Therapy Clinic/Center
Primary
PT12456
CA
291U00000X
Clinical Medical Laboratory
A97751
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679730923
—
CA
Enumeration date
02/06/2017
Last updated
02/06/2017
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