Provider Demographics
NPI:1225404957
Name:PAIN MANAGEMENT CENTER OF IRVINE, INC.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF IRVINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-641-4359
Mailing Address - Street 1:4902 IRVINE CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3334
Mailing Address - Country:US
Mailing Address - Phone:949-857-4712
Mailing Address - Fax:949-857-4797
Practice Address - Street 1:4902 IRVINE CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3334
Practice Address - Country:US
Practice Address - Phone:949-857-4712
Practice Address - Fax:949-857-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74030208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty