Provider Demographics
NPI:1811390602
Name:EAST BAY PAIN MANAGEMENT CENTER, INC
Entity Type:Organization
Organization Name:EAST BAY PAIN MANAGEMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-250-7447
Mailing Address - Street 1:7351 BRENTWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7313
Mailing Address - Country:US
Mailing Address - Phone:925-516-5656
Mailing Address - Fax:925-516-5943
Practice Address - Street 1:7351 BRENTWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7313
Practice Address - Country:US
Practice Address - Phone:925-516-5656
Practice Address - Fax:925-516-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25146111N00000X
CAA128252207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty