1972724987 NPI number — AMERICAN PAIN INSTITUE SURGICAL MEDICAL CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972724987 NPI number — AMERICAN PAIN INSTITUE SURGICAL MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN PAIN INSTITUE SURGICAL MEDICAL CENTER INC
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:
6
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:
1972724987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10610 LOWER AZUSA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91731-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-279-1855
Provider Business Mailing Address Fax Number:
626-279-9455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10610 LOWER AZUSA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-279-1855
Provider Business Practice Location Address Fax Number:
626-279-9455
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOMINGUEZ
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
626-279-1855

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  IMQ 10174 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FNP 31042 . This is a "FICTITIOUS NAME PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: IMQ ACCREDITATION . This is a "10174" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 18948 . This is a "CITY BUSINESS LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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