Provider Demographics
NPI:1710433594
Name:ABACI AND MASSEY PAIN MANAGEMENT, A MEDICAL COPORATION
Entity Type:Organization
Organization Name:ABACI AND MASSEY PAIN MANAGEMENT, A MEDICAL COPORATION
Other - Org Name:BAY AREA PAIN AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-364-6799
Mailing Address - Street 1:15047 LOS GATOS BLVD.
Mailing Address - Street 2:#200
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-364-6799
Mailing Address - Fax:
Practice Address - Street 1:15047 LOS GATOS BLVD
Practice Address - Street 2:#200
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2054
Practice Address - Country:US
Practice Address - Phone:408-364-6799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT93623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty