Provider Demographics
NPI:1467428557
Name:MOUNTAIN HEALTH PAIN MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MOUNTAIN HEALTH PAIN MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMASURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-755-0857
Mailing Address - Street 1:395 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4121
Mailing Address - Country:US
Mailing Address - Phone:530-755-0857
Mailing Address - Fax:530-755-0327
Practice Address - Street 1:395 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4121
Practice Address - Country:US
Practice Address - Phone:530-755-0857
Practice Address - Fax:530-755-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR21711Medicare UPIN
CAA25994Medicare UPIN