Healthcare Provider Details

I. General information

NPI: 1245876937
Provider Name (Legal Business Name): DTLA PAIN SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 10/18/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE SUITE 380
LOS ANGELES CA
90015-3070
US

IV. Provider business mailing address

5 HOLLAND SUITE 101
IRVINE CA
92618-2568
US

V. Phone/Fax

Practice location:
  • Phone: 949-872-2633
  • Fax: 888-885-5414
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

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: HASAN BADDAY
Title or Position: OWNER
Credential:
Phone: 949-872-2633