Provider Demographics
NPI:1629553730
Name:ADVANCED PAIN MANAGEMENT MEDICAL GROUP
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT MEDICAL GROUP
Other - Org Name:ADVANCED PAIN MANAGEMENT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-288-5700
Mailing Address - Street 1:23861 MCBEAN PKWY STE B18
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4456
Mailing Address - Country:US
Mailing Address - Phone:661-288-7978
Mailing Address - Fax:
Practice Address - Street 1:23861 MCBEAN PKWY STE B18
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4456
Practice Address - Country:US
Practice Address - Phone:661-288-7978
Practice Address - Fax:661-288-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000C425720Medicaid