1437700465 NPI number — ADVANCED PAIN CENTER, INC.

Table of content: (NPI 1437700465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437700465 NPI number — ADVANCED PAIN CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PAIN 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:
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:
1437700465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16952 VENTURA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-4197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-290-5949
Provider Business Mailing Address Fax Number:
888-885-5414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16952 VENTURA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91316-4197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-290-5949
Provider Business Practice Location Address Fax Number:
888-885-5414
Provider Enumeration Date:
09/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SHIRAZY
Authorized Official First Name:
PEJMAN
Authorized Official Middle Name:
ELI
Authorized Official Title or Position:
PRESIDENT, OWNER
Authorized Official Telephone Number:
818-290-5949

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1669470068 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com