NPIMap

Organization Active NPI

Myodetox California PC Inc.

Doing business as Myodetox

  • Physical Therapy Clinic/Center
  • West Hollywood, CA
National Provider Identifier
1891482519
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
MYODETOX CALIFORNIA PC INC.
Doing business as
Myodetox
Practice address
8354 Santa Monica Blvd
West Hollywood, CA 90069-4313
Phone
(323) 831-2455
NPI assigned
Apr 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Authorized official

Name
Scott Marcaccio
Title
Assistant Secretary
Phone
(917) 327-0019

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

8354 Santa Monica Blvd
West Hollywood, CA 90069-4313

Mailing address

8354 Santa Monica Blvd
West Hollywood, CA 90069-4313

Other practice location 1

11611 San Vicente Blvd
Los Angeles, CA 90049-5106
Phone (323) 430-6630

Other practice location 2

12833 Ventura Blvd Unit 153
Studio City, CA 91604-2368
Phone (323) 826-5277

Other names 1

  • Myodetox Doing business as

National Provider Directory

National Provider Directory

Locations

12833 Ventura Blvd
Unit 153
Studio City, CA 91604
Phone (323) 826-5277

8354 Santa Monica Blvd
West Hollywood, CA 90069
Phone (323) 831-2455

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1891482519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8354 SANTA MONICA BLVD",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900694313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8354 SANTA MONICA BLVD",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900694313",
            "telephone_number": "323-831-2455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11611 San Vicente Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900495106",
            "country_code": "US",
            "telephone_number": "323-430-6630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12833 Ventura Blvd Unit 153",
            "address_purpose": "LOCATION",
            "city": "Studio City",
            "state": "CA",
            "postal_code": "916042368",
            "country_code": "US",
            "telephone_number": "323-826-5277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MYODETOX CALIFORNIA PC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "MARCACCIO",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "917-327-0019"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Myodetox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.