Healthcare Provider Details

I. General information

NPI: 1245783364
Provider Name (Legal Business Name): MM PAIN MANAGEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 39TH ST
SACRAMENTO CA
95816-5502
US

IV. Provider business mailing address

1007 39TH ST
SACRAMENTO CA
95816-5502
US

V. Phone/Fax

Practice location:
  • Phone: 877-205-3537
  • Fax:
Mailing address:
  • Phone: 877-205-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number16210
License Number StateCA

VIII. Authorized Official

Name: WEI LI
Title or Position: OWNER
Credential:
Phone: 877-205-3537