Provider Demographics
NPI:1619739562
Name:ZENITH PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ZENITH PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-203-5632
Mailing Address - Street 1:2929 N 75TH AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5443
Mailing Address - Country:US
Mailing Address - Phone:480-203-5632
Mailing Address - Fax:
Practice Address - Street 1:420 E SOUTHERN AVE STE 101B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4945
Practice Address - Country:US
Practice Address - Phone:602-461-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty