Healthcare Provider Details

I. General information

NPI: 1861760670
Provider Name (Legal Business Name): PAIN CARE PROVIDERS A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY 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 TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

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