Provider Demographics
NPI:1225791171
Name:GREATER LA PAIN SPECIALISTS INC
Entity Type:Organization
Organization Name:GREATER LA PAIN SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HRIPSIME
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-808-8811
Mailing Address - Street 1:3300 FOOTHILL BLVD UNIT 12359
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-7042
Mailing Address - Country:US
Mailing Address - Phone:747-277-4555
Mailing Address - Fax:
Practice Address - Street 1:12626 RIVERSIDE DR STE 306
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3477
Practice Address - Country:US
Practice Address - Phone:747-277-4555
Practice Address - Fax:747-277-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A15266OtherMEDICAL LICENSE