MEDICARE: ADVANCED PAIN MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1043080187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PAIN MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	7230 MEDICAL CENTER DR STE 500
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4024
Country	:	US
Telephone Number	:	818-348-7246
Fax Number	:	818-348-7248

Provider Business Practice Location Address
First Line	:	4323 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4715
Country	:	US
Telephone Number	:	818-348-7246
Fax Number	:	818-348-7248

Authorized Official
Title or Position	:	C.O.O
Name	:	JACQUELINE SARIAN
Credential	:
Telephone Number	:	818-348-7246

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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