Provider Demographics
NPI:1760740674
Name:CORONA PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:CORONA PAIN MANAGEMENT CENTER
Other - Org Name:CORONA SPECIALTY CARE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHURAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-7246
Mailing Address - Street 1:31569 CANYON ESTATES DR STE 135
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0472
Mailing Address - Country:US
Mailing Address - Phone:951-734-7246
Mailing Address - Fax:
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-734-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical