1386816668 NPI number — EAST VALLEY PAIN CENTER, P.C.

Table of content: (NPI 1386816668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386816668 NPI number — EAST VALLEY PAIN CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST VALLEY PAIN CENTER, P.C.
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:
1386816668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 N FAIR OAKS AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91103-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-696-1400
Provider Business Mailing Address Fax Number:
626-696-1451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1744 E BOSTON ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85295-6236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-632-0057
Provider Business Practice Location Address Fax Number:
480-632-1237
Provider Enumeration Date:
03/27/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VARGA
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
626-696-1400

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  22099 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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