Healthcare Provider Details

I. General information

NPI: 1013478130
Provider Name (Legal Business Name): ADVANCED PAIN MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W AVENUE Q STE B
PALMDALE CA
93551-3894
US

IV. Provider business mailing address

7230 MEDICAL CENTER DR STE 500
WEST HILLS CA
91307-4024
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-7246
  • Fax: 818-348-7248
Mailing address:
  • Phone: 818-348-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACKIE SARIAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 818-348-7246