Healthcare Provider Details

I. General information

NPI: 1831978147
Provider Name (Legal Business Name): LA PAIN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W BROADWAY
GLENDALE CA
91204-1208
US

IV. Provider business mailing address

5256 LOS ENCANTOS WAY
LOS ANGELES CA
90027-1020
US

V. Phone/Fax

Practice location:
  • Phone: 323-243-2052
  • Fax:
Mailing address:
  • Phone: 323-243-2052
  • Fax:

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: DANIEL DERMENDJIAN
Title or Position: OWNER
Credential:
Phone: 323-243-2052