Provider Demographics
NPI:1124384615
Name:PACIFIC PAIN MANAGMENT
Entity Type:Organization
Organization Name:PACIFIC PAIN MANAGMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATEF
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-847-3322
Mailing Address - Street 1:8700 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3207
Mailing Address - Country:US
Mailing Address - Phone:714-847-3322
Mailing Address - Fax:714-847-3993
Practice Address - Street 1:8700 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3207
Practice Address - Country:US
Practice Address - Phone:714-847-3322
Practice Address - Fax:714-847-3993
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC PAIN MANAGMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52751251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52751Medicare PIN