Provider Demographics
NPI:1275653362
Name:EAST BAY PAIN CARE, INC.
Entity Type:Organization
Organization Name:EAST BAY PAIN CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUERTAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAC
Authorized Official - Phone:510-444-2772
Mailing Address - Street 1:411 30TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3301
Mailing Address - Country:US
Mailing Address - Phone:510-444-2772
Mailing Address - Fax:510-444-2773
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3301
Practice Address - Country:US
Practice Address - Phone:510-444-2772
Practice Address - Fax:510-444-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30211111N00000X
CADC29674111N00000X
CAAC8559171100000X
CAAC8730171100000X
CAAC8446171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty