Provider Demographics
NPI:1306380985
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:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:SATYJIT
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-348-7246
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-348-7246
Mailing Address - Fax:818-348-7248
Practice Address - Street 1:2876 SYCAMORE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1530
Practice Address - Country:US
Practice Address - Phone:818-348-7246
Practice Address - Fax:818-348-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site