Healthcare Provider Details

I. General information

NPI: 1942502687
Provider Name (Legal Business Name): UNIVERSAL PAIN MANAGEMENT MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28212 KELLY JOHNSON PKWY SUITE 155
VALENCIA CA
91355-5084
US

IV. Provider business mailing address

819 AUTO CENTER DR
PALMDALE CA
93551-4599
US

V. Phone/Fax

Practice location:
  • Phone: 661-367-9788
  • Fax: 661-367-9789
Mailing address:
  • Phone: 661-267-6876
  • Fax: 661-267-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. SHAHIN A SADIK
Title or Position: PARTNER
Credential: M.D.
Phone: 661-267-6876