Provider Demographics
NPI:1134461890
Name:S&A PAIN MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:S&A PAIN MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-285-8866
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-8000
Mailing Address - Country:US
Mailing Address - Phone:818-366-0474
Mailing Address - Fax:818-474-7530
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUITE# 240
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2500
Practice Address - Country:US
Practice Address - Phone:818-366-0474
Practice Address - Fax:818-474-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85939261QP3300X
367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty