Provider Demographics
NPI:1275280075
Name:PAIN RELEASE CENTER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PAIN RELEASE CENTER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-890-8001
Mailing Address - Street 1:12215 VENTURA BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2521
Mailing Address - Country:US
Mailing Address - Phone:818-505-0816
Mailing Address - Fax:818-392-5092
Practice Address - Street 1:12215 VENTURA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2521
Practice Address - Country:US
Practice Address - Phone:818-505-0816
Practice Address - Fax:818-392-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty