Healthcare Provider Details

I. General information

NPI: 1063505733
Provider Name (Legal Business Name): ADVANCED PAIN TREATMENT AND DIAGNOSTICS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-1938
US

IV. Provider business mailing address

PO BOX 893520
TEMECULA CA
92589-3520
US

V. Phone/Fax

Practice location:
  • Phone: 800-394-4445
  • Fax: 706-650-1034
Mailing address:
  • Phone: 951-699-0303
  • Fax: 951-699-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEORGE GRAF
Title or Position: PRESIDENT
Credential: MD
Phone: 800-394-4445