Healthcare Provider Details

I. General information

NPI: 1134461890
Provider Name (Legal Business Name): S&A PAIN MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 VENTURA BLVD SUITE# 240
ENCINO CA
91436-2500
US

IV. Provider business mailing address

PO BOX 8000
NORTHRIDGE CA
91327-8000
US

V. Phone/Fax

Practice location:
  • Phone: 818-366-0474
  • Fax: 818-474-7530
Mailing address:
  • Phone: 818-366-0474
  • Fax: 818-474-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberA85939
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. ANUJ GUPTA
Title or Position: OWNER
Credential: M.D.
Phone: 760-285-8866