Provider Demographics
NPI:1356818736
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/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-348-7246
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4024
Mailing Address - Country:US
Mailing Address - Phone:818-348-7246
Mailing Address - Fax:818-348-7248
Practice Address - Street 1:27600 BOUQUET CANYON RD STE 106
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3715
Practice Address - Country:US
Practice Address - Phone:661-414-5335
Practice Address - Fax:661-414-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty