Provider Demographics
NPI:1043408941
Name:CASTORIA SEYMORE, JR. MD A PROFESSIONAL CORPERATION
Entity Type:Organization
Organization Name:CASTORIA SEYMORE, JR. MD A PROFESSIONAL CORPERATION
Other - Org Name:SOUTHERN CALIFORNIA PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CASTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:1310-482-6906
Mailing Address - Street 1:4644 LINCOLN BLVD
Mailing Address - Street 2:424
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:131-048-2690
Mailing Address - Fax:131-048-2695
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:424
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:131-048-2690
Practice Address - Fax:131-048-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty