Provider Demographics
NPI:1275168676
Name:ADVANCED PAIN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ADVANCED PAIN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-348-7246
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4024
Mailing Address - Country:US
Mailing Address - Phone:818-348-7246
Mailing Address - Fax:
Practice Address - Street 1:100 OCEANGATE STE P280
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4390
Practice Address - Country:US
Practice Address - Phone:818-348-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PAIN MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty