1538649751 NPI number — ON PAIN MEDICAL, INC

Table of content: (NPI 1538649751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538649751 NPI number — ON PAIN MEDICAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON PAIN MEDICAL, 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:
ON PAIN MEDICAL, INC
Provider Other Organization Name Type Code:
3
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:
1538649751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4712 ADMIRALTY WAY # 544
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90292-6905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-751-4337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 SANTA MONICA BLVD STE 1280W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-2230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-264-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARNARD
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-751-4337

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  A132634 , 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)