MEDICARE: CENTER FOR PAIN CONTROL IN CALIFORNIA-MEDICAL ASSOCIATES

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	A47841	CA
2	261QP3300X	Pain Clinic/Center	A54399	CA

General Provider Information

NPI Number	:	1780824888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PAIN CONTROL IN CALIFORNIA-MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 8000
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91327-8000
Country	:	US
Telephone Number	:	818-366-0474
Fax Number	:	818-474-7530

Provider Business Practice Location Address
First Line	:	11145 TAMPA AVE
Second Line	:	21B
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2255
Country	:	US
Telephone Number	:	818-366-0474
Fax Number	:	818-474-7530

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DR. SHUBHA M JAIN
Credential	:	M.D.
Telephone Number	:	818-366-0474

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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