Provider Demographics
NPI:1437700465
Name:ADVANCED PAIN CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED PAIN CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:SHIRAZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-290-5949
Mailing Address - Street 1:16952 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4197
Mailing Address - Country:US
Mailing Address - Phone:818-290-5949
Mailing Address - Fax:888-885-5414
Practice Address - Street 1:16952 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4197
Practice Address - Country:US
Practice Address - Phone:818-290-5949
Practice Address - Fax:888-885-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669470068Medicaid