Reza Borna MD Inc

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

REZA BORNA MD INC

Doing business as

KETAMINE HAVEN CLINIC

Practice address

18321 Ventura Blvd Ste 815
Tarzana, CA 91356-4251

Phone

(747) 836-3803

NPI assigned

Nov 6, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Reza Borna, MDNPI 1649406778

Title

Proprietor

Phone

(747) 836-3803

Specialties & licenses 1

Addresses

Other names 1

• KETAMINE HAVEN CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Reza Mehryar Borna, M.D.

  • Anesthesiology Physician
  • Los Angeles, CA
  • NPI 1649406778
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1861215907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18321 VENTURA BLVD STE 815",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564251",
            "telephone_number": "747-836-3803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18321 VENTURA BLVD STE 815",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564251",
            "telephone_number": "747-836-3803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REZA BORNA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-06",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "BORNA",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "747-836-3803",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KETAMINE HAVEN CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julie Reyes
• Natalie N Reyes
• Nicolette Anne Goto Reyes
• Jessica Reynaga, LPCC
• Ruben Reynoso
• Frank Reza
• Bella Reznik, D.D.S.
• Thomas Patrick Rezzo, D.D.S.
• Elysse Rhodes
• Richard Alan Shapiro MD Inc

• Anesthesiology Physician in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.