MEDICARE: LIBRA PAIN CARE

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	A126658	CA
2	208VP0000X	Pain Medicine Physician	A126658	CA
3	207R00000X	Internal Medicine Physician	A126658	CA
4	208VP0014X	Interventional Pain Medicine Physician	A126658	CA

General Provider Information

NPI Number	:	1477952117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBRA PAIN CARE

Provider Business Mailing Address
First Line	:	1433 W MERCED AVE STE 103
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-3402
Country	:	US
Telephone Number	:	626-506-2648
Fax Number	:	626-898-9250

Provider Business Practice Location Address
First Line	:	1433 W MERCED AVE STE 103
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-3402
Country	:	US
Telephone Number	:	626-506-2648
Fax Number	:	626-898-9250

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAM AHDAB
Credential	:	M.D.
Telephone Number	:	323-217-2856

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	02/04/2026

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Directions to “LIBRA PAIN CARE ” Practice Location

Language	Start Address	Practice Location

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