1538342357 NPI number — THERAPEUTIC PAIN MANAGEMENT

Table of content: (NPI 1538342357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538342357 NPI number — THERAPEUTIC PAIN MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC PAIN MANAGEMENT
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:
1538342357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6929 N WILLOW AVE
Provider Second Line Business Mailing Address:
STE #103
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93710-5956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-323-7246
Provider Business Mailing Address Fax Number:
559-323-7271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6929 N WILLOW AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-5956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-323-7246
Provider Business Practice Location Address Fax Number:
559-323-7271
Provider Enumeration Date:
12/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PIAZZA
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OWNER-PRESIDENT
Authorized Official Telephone Number:
559-323-7246

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  53036 , 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: 19253/19150 . This is a "CA STATE EXEMPTEE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 53036 . This is a "DMEPOS RETAILER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1538342357 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: S11165 . This is a "ACCREDIDATION-BOARD OF ORTHOTICS AND PROSTHETICS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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