Provider Demographics
NPI:1235370768
Name:PAIN MANAGEMENT CENTER ALEJANDRO KATZ LICENSED ACUPUNCTURIST, INC.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTER ALEJANDRO KATZ LICENSED ACUPUNCTURIST, INC.
Other - Org Name:PAIN MANAGEMENT CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:OMD L AC
Authorized Official - Phone:213-387-4710
Mailing Address - Street 1:5567 RESEDA BLVD
Mailing Address - Street 2:# 101
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2674
Mailing Address - Country:US
Mailing Address - Phone:213-387-4710
Mailing Address - Fax:213-387-4811
Practice Address - Street 1:5567 RESEDA BLVD
Practice Address - Street 2:# 101
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2674
Practice Address - Country:US
Practice Address - Phone:213-387-4710
Practice Address - Fax:213-387-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33075111N00000X
CADC15287111N00000X
CAAC2332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972694453OtherNPI
CA1740274976OtherINDIVITUAL NPI
CA1235370768OtherNPI