Healthcare Provider Details

I. General information

NPI: 1578627022
Provider Name (Legal Business Name): PAIN CARE PROVIDERS A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY SUITE 345
IRVINE CA
92618-3167
US

IV. Provider business mailing address

PO BOX 54788
IRVINE CA
92619-4788
US

V. Phone/Fax

Practice location:
  • Phone: 949-872-2400
  • Fax: 949-872-2401
Mailing address:
  • Phone: 949-872-2400
  • Fax: 949-872-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA81189
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA81189
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA81189
License Number StateCA

VIII. Authorized Official

Name: AMIR BAHRAM RAFIZAD
Title or Position: PRESIDENT
Credential: M. D.
Phone: 949-872-2400