1053659995 NPI number — PAIN ALLEVIA MEDICAL CORPORATION

Table of content: (NPI 1053659995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053659995 NPI number — PAIN ALLEVIA MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN ALLEVIA MEDICAL 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:
1053659995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5333
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90510-5333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-777-2469
Provider Business Mailing Address Fax Number:
714-777-2427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15611 POMERADO RD
Provider Second Line Business Practice Location Address:
SUITE 525
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064-2437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-613-6252
Provider Business Practice Location Address Fax Number:
858-798-1225
Provider Enumeration Date:
01/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHONG
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
OWNER/ PRESIDENT
Authorized Official Telephone Number:
808-392-0512

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  A103353 , 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)





Copyright © 2007-2025 www.npivalidator.com