Organization
PACIFIC INTEGRATIVE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN ANATOL VASILEV MD (PROGRAM SPARE HOLDER - VP)
(310) 393-2225
Entity
Organization
Contact information
Practice address
2232 SANTA MONICA BLVD # 101, SANTA MONICA, CA 90404-2312
(310) 393-2225
(310) 393-3321
Mailing address
2232 SANTA MONICA BLVD # 101, SANTA MONICA, CA 90404-2312
(310) 393-2225
(310) 393-3321
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
07/22/2020
Last updated
08/06/2020
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