Healthcare Provider Details

I. General information

NPI: 1275059727
Provider Name (Legal Business Name): ADVANCE PAIN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N LA CIENEGA BLVD STE 201
BEVERLY HILLS CA
90211-2246
US

IV. Provider business mailing address

7230 MEDICAL CENTER DR STE 500
WEST HILLS CA
91307-4024
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-7246
  • Fax: 818-348-7248
Mailing address:
  • Phone: 818-348-7253
  • Fax: 818-348-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE SARIAN
Title or Position: C.O.O.
Credential:
Phone: 818-348-7246