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General NPI Number Information
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NPI Number | 1245876937
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Entity Type | Organization
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Legal Business Name | DTLA PAIN SURGERY CENTER INC
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 1513 S GRAND AVE SUITE 380
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City | LOS ANGELES
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State | CA
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Zip | 90015-3070
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Country | US
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Telephone | 949-872-2633
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Fax | 888-885-5414
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Provider Business Mailing Address
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Address Line | 5 HOLLAND SUITE 101
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City | IRVINE
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State | CA
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Zip | 92618-2568
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Authorized Official
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Title or Position | OWNER
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Name | HASAN BADDAY
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Credential |
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Telephone | 949-872-2633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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