Healthcare Provider Details

I. General information

NPI: 1053429381
Provider Name (Legal Business Name): PAIN ASSOCIATES OF MERCED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 E YOSEMITE AVE STE C
MERCED CA
95340-9659
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 209-724-0316
  • Fax: 209-724-0318
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAMAKRISHNA R THONDAPU
Title or Position: PARTNER
Credential: MD
Phone: 209-724-0316