Provider Demographics
NPI:1063511475
Name:ALEXANDER P. HERSEL, M.D., INC
Entity Type:Organization
Organization Name:ALEXANDER P. HERSEL, M.D., INC
Other - Org Name:PAIN MANAGEMENT & INJURY RELIEF MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-367-7522
Mailing Address - Street 1:415 ROLLING OAKS DR
Mailing Address - Street 2:110
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1029
Mailing Address - Country:US
Mailing Address - Phone:805-557-0096
Mailing Address - Fax:805-557-7360
Practice Address - Street 1:1120 NEWBURY RD # 150
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-3663
Practice Address - Country:US
Practice Address - Phone:805-557-0096
Practice Address - Fax:805-557-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79277207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI07236Medicare UPIN
CAWA79277BMedicare ID - Type UnspecifiedMEMBER ID - THOUSAND OAKS
CAW17332AMedicare ID - Type UnspecifiedGROUP ID - THOUSAND OAKS