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General NPI Number Information
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NPI Number | 1902941271
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Entity Type | Organization
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Legal Business Name | PAIN & ADDICTION MEDICINE ASSOC. OF SO CAL
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 16260 VENTURA BLVD STE 309
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City | ENCINO
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State | CA
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Zip | 91436-2203
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Country | US
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Telephone | 818-906-7643
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Fax | 818-906-7641
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Provider Business Mailing Address
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Address Line | 16260 VENTURA BLVD STE 309
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City | ENCINO
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State | CA
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Zip | 91436-2203
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Country | US
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Telephone | 818-906-7643
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Fax | 818-906-7641
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Authorized Official
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Title or Position | OWNER
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Name | DR. VADIM LIPEL
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Credential | MD, CEO
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Telephone | 818-906-7643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A63487
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License Number State | CA
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