MEDICARE: INTERVENTIONAL PAIN MEDICAL GROUP

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1932207248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 3969
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-3969
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:	562-407-2082

Provider Business Practice Location Address
First Line	:	1601 DOVE ST
Second Line	:	SUITE 170
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2433
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:	562-407-2082

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN FRANCIS PETRAGLIA
Credential	:	M.D.
Telephone Number	:	562-407-2080

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/09/2010

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Directions to “INTERVENTIONAL PAIN MEDICAL GROUP ” Practice Location

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