Healthcare Provider Details

I. General information

NPI: 1932139821
Provider Name (Legal Business Name): PAIN MANAGEMENT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 LONG BEACH BLVD SUITE 105
LONG BEACH CA
90807-3941
US

IV. Provider business mailing address

3545 LONG BEACH BLVD SUITE 105
LONG BEACH CA
90807-3941
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-0060
  • Fax: 562-981-0916
Mailing address:
  • Phone: 562-595-0060
  • Fax: 562-981-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEDHAT FOUAD MIKHAEL
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 562-595-0060