Healthcare Provider Details

I. General information

NPI: 1568705010
Provider Name (Legal Business Name): INTELLIGENT PAIN SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-1951
US

IV. Provider business mailing address

PO BOX 893520
TEMECULA CA
92589-3520
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-0282
  • Fax: 310-854-0284
Mailing address:
  • Phone: 951-699-0303
  • Fax: 951-296-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG64260
License Number StateCA

VIII. Authorized Official

Name: MR. GEORGE GRAF
Title or Position: PARTNER
Credential: MD
Phone: 310-854-0282