MEDICARE: GOLD COAST PAIN AND WELLNESS CENTER A MEDICAL CORPORATION

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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1770432296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST PAIN AND WELLNESS CENTER A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1111 LAS TABLAS RD STE 0
Second Line	:
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9732
Country	:	US
Telephone Number	:	310-625-5848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 LAS TABLAS RD STE 0
Second Line	:
City	:	TEMPLETON
State	:	CA
Zip	:	93465-9732
Country	:	US
Telephone Number	:	310-625-5848
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHAHRIAR PIROUZ
Credential	:	MD
Telephone Number	:	310-625-5848

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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