Healthcare Provider Details

I. General information

NPI: 1992943666
Provider Name (Legal Business Name): PACIFIC PAIN CONTROL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVS # 612
LOS ANGELES CA
90069
US

IV. Provider business mailing address

7439 LA PALMA AVE # 120
BUENA PARK CA
90620-2698
US

V. Phone/Fax

Practice location:
  • Phone: 714-522-2001
  • Fax: 714-522-7503
Mailing address:
  • Phone: 714-522-2001
  • Fax: 714-522-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberFNP21284
License Number StateCA

VIII. Authorized Official

Name: MUSYA BRANOVAN
Title or Position: OWNER
Credential:
Phone: 714-522-2001