MEDICARE: PAIN MANAGEMENT AND AESTHETIC SURGERY CENTER IN BEVERLY HILLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1215594379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT AND AESTHETIC SURGERY CENTER IN BEVERLY HILLS

Provider Business Mailing Address
First Line	:	1925 ROYAL AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-4619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 ROYAL AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-4619
Country	:	US
Telephone Number	:	818-366-0474
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAIN SHUBHA
Credential	:
Telephone Number	:	818-366-0474

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	07/06/2021

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