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General NPI Number Information
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NPI Number | 1972988178
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Entity Type | Organization
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Legal Business Name | PACIFIC PAIN INSTITUTE
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 2410 MERCED ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4211
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Country | US
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Telephone | 510-278-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 MERCED ST
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TOUFAN RAZI
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Credential | MD, QME
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Telephone | 510-278-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 52653
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License Number State | CA
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