1235374372 NPI number — MISSION HILLS PAIN MANAGEMENT MEDICAL CORPORATION

Table of content: (NPI 1235374372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235374372 NPI number — MISSION HILLS PAIN MANAGEMENT MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION HILLS PAIN MANAGEMENT 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:
1235374372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 515804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90051-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-493-3800
Provider Business Mailing Address Fax Number:
909-204-7868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19871 NORDHOFF ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-359-8833
Provider Business Practice Location Address Fax Number:
877-727-9225
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARFAI
Authorized Official First Name:
KIUMARS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
818-359-8833

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  0002402666-0001-2 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com