Provider Demographics
NPI:1407047715
Name:MENLO PARK PAIN RELIEF CENTER
Entity Type:Organization
Organization Name:MENLO PARK PAIN RELIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-380-0137
Mailing Address - Street 1:1620 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4112
Mailing Address - Country:US
Mailing Address - Phone:650-380-0137
Mailing Address - Fax:650-321-8815
Practice Address - Street 1:1620 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4112
Practice Address - Country:US
Practice Address - Phone:650-380-0137
Practice Address - Fax:650-321-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16314261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center