Healthcare Provider Details

I. General information

NPI: 1548333586
Provider Name (Legal Business Name): PREVENT THE PAIN THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8818 SATURN ST
LOS ANGELES CA
90035-3320
US

IV. Provider business mailing address

PO BOX 6520
BEVERLY HILLS CA
90212-6520
US

V. Phone/Fax

Practice location:
  • Phone: 310-623-4444
  • Fax: 310-623-4455
Mailing address:
  • Phone: 310-623-4444
  • Fax: 310-623-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number25506
License Number StateCA

VIII. Authorized Official

Name: MS. VIVIAN GAYLE EISENSTADT
Title or Position: CEO
Credential: M.A.P.T.,O.C.S.
Phone: 310-623-4444