Healthcare Provider Details

I. General information

NPI: 1710246830
Provider Name (Legal Business Name): PAIN DYNAMICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 MCGAW AVE STE B SUITE B
IRVINE CA
92614-5670
US

IV. Provider business mailing address

1565 MCGAW AVE STE B SUITE B
IRVINE CA
92614-5670
US

V. Phone/Fax

Practice location:
  • Phone: 949-973-6112
  • Fax: 562-424-7601
Mailing address:
  • Phone: 949-973-6112
  • Fax: 562-424-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID WHITE
Title or Position: DIRECTOR
Credential:
Phone: 949-973-6112