Healthcare Provider Details

I. General information

NPI: 1861933749
Provider Name (Legal Business Name): ADVANCED PAIN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JENSEN CT STE 1C
THOUSAND OAKS CA
91360-7484
US

IV. Provider business mailing address

7230 MEDICAL CENTER DR SUITE 500
WEST HILLS CA
91307-1907
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIMAL SATYJIT LALA
Title or Position: PRESIDENT / OWNER
Credential: D.O., M.P.H.
Phone: 818-348-7246