1942502687 NPI number — UNIVERSAL PAIN MANAGEMENT MEDICAL CORP

Table of content: (NPI 1942502687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942502687 NPI number — UNIVERSAL PAIN MANAGEMENT MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL PAIN MANAGEMENT MEDICAL CORP
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:
1942502687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 AUTO CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-4599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-267-6876
Provider Business Mailing Address Fax Number:
661-267-0438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28212 KELLY JOHNSON PKWY
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-5084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-367-9788
Provider Business Practice Location Address Fax Number:
661-367-9789
Provider Enumeration Date:
12/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SADIK
Authorized Official First Name:
SHAHIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
661-267-6876

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , 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)





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