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General NPI Number Information
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NPI Number | 1235470634
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Entity Type | Organization
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Legal Business Name | PACIFIC SPINE AND PAIN CENTER INC
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Dates
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Enumeration Date | 03/09/2013
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Last Update Date | 06/02/2013
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Provider Practice Location Address
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Address Line | 805 W ACEQUIA AVE STE 1D
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City | VISALIA
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State | CA
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Zip | 93291-6163
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Country | US
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Telephone | 559-713-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 805 W ACEQUIA AVE STE 1D
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City | VISALIA
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State | CA
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Zip | 93291-6163
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Country | US
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Telephone | 559-713-6515
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BRANDON SORENSEN
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Credential | M.D.
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Telephone | 559-713-6515
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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 | A124459
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License Number State | CA
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