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General NPI Number Information
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NPI Number | 1992943666
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Entity Type | Organization
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Legal Business Name | PACIFIC PAIN CONTROL CLINIC
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 9201 W SUNSET BLVS # 612
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City | LOS ANGELES
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State | CA
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Zip | 90069
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Country | US
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Telephone | 714-522-2001
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Fax | 714-522-7503
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Provider Business Mailing Address
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Address Line | 7439 LA PALMA AVE # 120
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City | BUENA PARK
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State | CA
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Zip | 90620-2698
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Country | US
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Telephone | 714-522-2001
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Fax | 714-522-7503
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Authorized Official
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Title or Position | OWNER
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Name | MUSYA BRANOVAN
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Credential |
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Telephone | 714-522-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | FNP21284
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License Number State | CA
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