NPIMap

Organization Active NPI

Ketamine Clinics LLC

Doing business as Ketamine Clinics of Los Angeles

  • Ambulatory Surgical Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1154894616
Registry record updated Jan 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
KETAMINE CLINICS LLC
Doing business as
Ketamine Clinics of Los Angeles
Practice address
6801 Park Ter Ste 525
Los Angeles, CA 90045-1543
Phone
(310) 270-0625
NPI assigned
Jan 8, 2019
Last updated
Jan 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel Herbert Mandel
Title
Chief Operating Officer
Phone
(310) 270-0625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

6801 Park Ter Ste 525
Los Angeles, CA 90045-1543

Mailing address

6801 Park Ter Ste 525
Los Angeles, CA 90045-1543
Phone (310) 270-0625

Other practice location 1

11645 Wilshire Blvd Ste 852
Los Angeles, CA 90025-6808
Phone (310) 270-0625

Other names 1

  • Ketamine Clinics of Los Angeles Doing business as

National Provider Directory

National Provider Directory

Locations

11645 Wilshire Blvd
Ste 852
Los Angeles, CA 90025
Phone (310) 270-0625

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1154894616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 PARK TER STE 525",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900451543",
            "telephone_number": "310-270-0625",
            "fax_number": "310-730-5993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 PARK TER STE 525",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900451543",
            "telephone_number": "310-270-0625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11645 Wilshire Blvd Ste 852",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900256808",
            "country_code": "US",
            "telephone_number": "310-270-0625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KETAMINE CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-08",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "MANDEL",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "HERBERT",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "310-270-0625"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Clinics of Los Angeles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.