Healthcare Provider Details

I. General information

NPI: 1770027856
Provider Name (Legal Business Name): ADVANCED PAIN MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ROLLING OAKS DR SUITE 100
THOUSAND OAKS CA
91361-1010
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 TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: VIMAL SATYJIT LALA
Title or Position: PHYSICIAN / OWNER
Credential: D.O.
Phone: 818-348-7246