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General NPI Number Information
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NPI Number | 1871931238
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Entity Type | Organization
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Legal Business Name | ARROYO VISTA ADVANCED PAIN SPECIALISTS, INC
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 865 PATRIOT DR STE 201A
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City | MOORPARK
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State | CA
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Zip | 93021-3405
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Country | US
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Telephone | 805-222-4549
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Fax | 805-529-4549
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Provider Business Mailing Address
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Address Line | 530 W LOS ANGELES AVE STE 115 MS-343
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City | MOORPARK
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State | CA
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Zip | 93021-1746
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Country | US
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Telephone | 805-222-4549
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Fax | 805-529-4549
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Authorized Official
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Title or Position | CEO/CMO
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Name | DR. LANA LOUIE ALVAREZ WANIA-GALICIA
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Credential | M.D.
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Telephone | 805-222-4549
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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 |
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License Number State |
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