Provider Demographics
NPI:1346792462
Name:NUVATION PAIN GROUP
Entity Type:Organization
Organization Name:NUVATION PAIN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-676-5541
Mailing Address - Street 1:5832 BEACH BLVD UNIT 210
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-5501
Mailing Address - Country:US
Mailing Address - Phone:714-676-5541
Mailing Address - Fax:714-676-5542
Practice Address - Street 1:5832 BEACH BLVD UNIT 208
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-5501
Practice Address - Country:US
Practice Address - Phone:714-676-5541
Practice Address - Fax:714-676-5542
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUVATION PAIN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-25
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9128332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies