Provider Demographics
NPI:1306021159
Name:ADVANCED PAIN TREATMENT MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED PAIN TREATMENT MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-548-5481
Mailing Address - Street 1:1412 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3507
Mailing Address - Country:US
Mailing Address - Phone:310-548-5481
Mailing Address - Fax:310-548-5000
Practice Address - Street 1:1412 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3507
Practice Address - Country:US
Practice Address - Phone:310-548-5481
Practice Address - Fax:310-548-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50028261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50028BMedicare PIN