Healthcare Provider Details

I. General information

NPI: 1588795447
Provider Name (Legal Business Name): LANCASTER PAIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 10TH ST W SUITE 110
LANCASTER CA
93534-3033
US

IV. Provider business mailing address

44725 10TH ST W SUITE 110
LANCASTER CA
93534-3033
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-9966
  • Fax: 661-949-9926
Mailing address:
  • Phone: 661-949-9966
  • Fax: 661-949-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207LP2900X
License Number StateCA

VIII. Authorized Official

Name: DR. CHITTA THIAGARAJAH
Title or Position: M.D.
Credential: M.D.
Phone: 661-949-9966