Healthcare Provider Details

I. General information

NPI: 1659013381
Provider Name (Legal Business Name): PRZYBYSZMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 WARNER AVENUE STE 102
HUNTINGTON BEACH CA
92649-4097
US

IV. Provider business mailing address

5355 WARNER AVENUE STE 102
HUNTINGTON BEACH CA
92649-4097
US

V. Phone/Fax

Practice location:
  • Phone: 714-790-9260
  • Fax: 714-793-9263
Mailing address:
  • Phone: 714-790-9260
  • Fax: 714-793-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AARON JOSEPH PRZYBYSZ
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 714-793-9260