Healthcare Provider Details

I. General information

NPI: 1134151236
Provider Name (Legal Business Name): ALPHA PAIN MANAGEMENT A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 WILSHIRE BLVD STE 202
BEVERLY HILLS CA
90211-1825
US

IV. Provider business mailing address

11693 SAN VICENTE BLVD # 112 11693 SAN VICENTE BLVD # 112
LOS ANGELES CA
90049-5105
US

V. Phone/Fax

Practice location:
  • Phone: 949-409-5482
  • Fax:
Mailing address:
  • Phone: 949-409-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA92212
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMMANUEL O EMENIKE
Title or Position: CEO/PHYSICIAN
Credential: M.D.
Phone: 310-883-5343