Healthcare Provider Details

I. General information

NPI: 1720730500
Provider Name (Legal Business Name): IN PAIN PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W WARDLOW RD
LONG BEACH CA
90807-4429
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 310-448-3459
  • Fax: 310-388-3259
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL PHILIP LODER
Title or Position: PRESIDENT
Credential:
Phone: 310-448-3459