Provider Demographics
NPI:1558994855
Name:CALIFORNIA PAIN CENTER PC
Entity Type:Organization
Organization Name:CALIFORNIA PAIN CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIPAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-660-8045
Mailing Address - Street 1:18960 VENTURA BLVD # 204
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3224
Mailing Address - Country:US
Mailing Address - Phone:818-660-8045
Mailing Address - Fax:818-588-4748
Practice Address - Street 1:5620 WILBUR AVE STE 301
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-660-8045
Practice Address - Fax:818-588-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty