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General NPI Number Information
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NPI Number | 1235447392
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Entity Type | Organization
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Legal Business Name | BEACH CITIES PAIN MANAGEMENT GROUP
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 514 N PROSPECT AVE STE 100
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3036
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Country | US
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Telephone | 310-376-2707
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Fax | 310-798-4600
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Provider Business Mailing Address
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Address Line | PO BOX 3098
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City | TORRANCE
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State | CA
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Zip | 90510-3098
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Country | US
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Telephone | 310-792-3914
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Fax | 310-792-3802
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY M CALLOWAY
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Credential | M.D.
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Telephone | 310-792-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G66639
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License Number State | CA
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