Provider Demographics
NPI:1235374372
Name:MISSION HILLS PAIN MANAGEMENT MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MISSION HILLS PAIN MANAGEMENT MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIUMARS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-359-8833
Mailing Address - Street 1:PO BOX 515804
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3104
Mailing Address - Country:US
Mailing Address - Phone:909-493-3800
Mailing Address - Fax:909-204-7868
Practice Address - Street 1:19871 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3331
Practice Address - Country:US
Practice Address - Phone:818-359-8833
Practice Address - Fax:877-727-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002402666-0001-2261QP3300X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABS779BMedicare Oscar/Certification