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General NPI Number Information
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NPI Number | 1558541870
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Entity Type | Organization
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Legal Business Name | ALESIA PAIN TREATMENT CENTER, A MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 2450 EL CAMINO REAL SUITE 100 B
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City | PALO ALTO
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State | CA
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Zip | 94306-1706
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Country | US
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Telephone | 650-493-7246
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Fax | 650-493-7248
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Provider Business Mailing Address
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Address Line | 2450 EL CAMINO REAL SUITE 100 B
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City | PALO ALTO
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State | CA
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Zip | 94306-1706
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Country | US
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Telephone | 650-493-7246
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Fax | 650-493-7248
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BRANDON TRUONG WYNN
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Credential | D.O.
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Telephone | 408-368-1889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 20A9059
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License Number State | CA
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