NPIMap

Organization Active NPI

Functional Restoration

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Encino, CA
National Provider Identifier
1184810319
Registry record updated Oct 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X
Legal business name
FUNCTIONAL RESTORATION
Practice address
18065 Ventura Blvd
Encino, CA 91316-3517
Phone
(818) 708-6163
Fax
(818) 708-6167
NPI assigned
Sep 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2007

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

Authorized official

Name
Dr. Moosa Heikali, M.D.
Title
President/Medical Director
Phone
(818) 708-6163

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychosomatic Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0015X
Pain Medicine (Psychiatry & Neurology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P2900X Primary

Addresses

Primary practice location

18065 Ventura Blvd
Encino, CA 91316-3517

Mailing address

PO Box 491149
Los Angeles, CA 90049-9149
Phone (818) 708-6163

National Provider Directory

National Provider Directory
Tax ID family
Functional Restoration Medical Center Inc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1184810319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491149",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900499149",
            "telephone_number": "818-708-6163",
            "fax_number": "818-708-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18065 VENTURA BLVD",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913163517",
            "telephone_number": "818-708-6163",
            "fax_number": "818-708-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL RESTORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "HEIKALI",
        "authorized_official_first_name": "MOOSA",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-708-6163",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; 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.