Healthcare Provider Details

I. General information

NPI: 1780548032
Provider Name (Legal Business Name): ADVANCED PAIN MANAGEMENT OF ARIZONA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S MILL AVE STE 101
TEMPE AZ
85282-2106
US

IV. Provider business mailing address

11522 MANCHESTER WAY
PORTER RANCH CA
91326-2459
US

V. Phone/Fax

Practice location:
  • Phone: 480-605-9700
  • Fax: 480-605-9700
Mailing address:
  • Phone: 480-415-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MANRAJ KHOSLA
Title or Position: MEDICAL DIRECTOR / OWNER
Credential: MD
Phone: 480-415-4253