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General NPI Number Information
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NPI Number | 1811158843
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Entity Type | Organization
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Legal Business Name | PYRAMID PAIN & REHAB P.A.
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 3500 INTERSTATE 30 BUILDING D, SUITE # 203
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City | MESQUITE
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State | TX
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Zip | 75150-2696
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Country | US
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Telephone | 214-765-6978
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Fax |
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Provider Business Mailing Address
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Address Line | 6447 MALAGA
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City | IRVING
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State | TX
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Zip | 75039-3191
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Country | US
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Telephone | 214-765-6978
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SREENADHA R VATTAM
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Credential | M.D.
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Telephone | 214-765-6978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | M2851
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License Number State | TX
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