1134461890 NPI number — S&A PAIN MANAGEMENT CORPORATION

Table of content: (NPI 1386387124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134461890 NPI number — S&A PAIN MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S&A PAIN MANAGEMENT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134461890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91327-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-366-0474
Provider Business Mailing Address Fax Number:
818-474-7530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16101 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE# 240
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-366-0474
Provider Business Practice Location Address Fax Number:
818-474-7530
Provider Enumeration Date:
03/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GUPTA
Authorized Official First Name:
ANUJ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-285-8866

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  A85939 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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