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General NPI Number Information
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NPI Number | 1134151236
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Entity Type | Organization
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Legal Business Name | ALPHA PAIN MANAGEMENT A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 4954 VAN NUYS BLVD STE 202
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1798
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Country | US
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Telephone | 310-694-0385
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Fax |
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Provider Business Mailing Address
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Address Line | 11693 SAN VICENTE BLVD # 112
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City | LOS ANGELES
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State | CA
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Zip | 90049-5105
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Country | US
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Telephone | 310-694-0385
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Fax |
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Authorized Official
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Title or Position | CEO/PHYSICIAN
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Name | DR. EMMANUEL O EMENIKE
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Credential | M.D.
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Telephone | 310-694-0385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A92212
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License Number State | CA
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