Healthcare Provider Details

I. General information

NPI: 1013750512
Provider Name (Legal Business Name): PAIN & INJURY INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 MOORPARK AVE STE 200
SAN JOSE CA
95128-2543
US

IV. Provider business mailing address

3097 MOORPARK AVE STE 200
SAN JOSE CA
95128-2543
US

V. Phone/Fax

Practice location:
  • Phone: 408-244-7246
  • Fax:
Mailing address:
  • Phone: 408-244-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JADALI
Title or Position: AUTHORIZED OFFICIAL
Credential: D.O.
Phone: 408-244-7246