1033396445 NPI number — APEX PAIN MANAGEMENT, INC

Table of content: (NPI 1033396445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033396445 NPI number — APEX PAIN MANAGEMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX PAIN MANAGEMENT, 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:
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:
1033396445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92628-4231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-278-9744
Provider Business Mailing Address Fax Number:
802-609-8535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 N RAYMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92831-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-278-9744
Provider Business Practice Location Address Fax Number:
802-609-8535
Provider Enumeration Date:
01/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KAYE
Authorized Official First Name:
VLADIMIR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-278-9744

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  A64244 , 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: A64244 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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