Healthcare Provider Details

I. General information

NPI: 1669117255
Provider Name (Legal Business Name): SOCAL PAIN CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 S COAST DR STE 303
COSTA MESA CA
92626-1528
US

IV. Provider business mailing address

1503 S COAST DR STE 303
COSTA MESA CA
92626-1528
US

V. Phone/Fax

Practice location:
  • Phone: 310-254-9015
  • Fax:
Mailing address:
  • Phone: 310-254-9015
  • 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: ALEX SABO
Title or Position: PRESIDENT
Credential:
Phone: 310-767-6019