Provider Demographics
NPI:1962439935
Name:CONEJO PAIN SPECIALISTS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CONEJO PAIN SPECIALISTS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-497-8616
Mailing Address - Street 1:430 E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3024
Mailing Address - Country:US
Mailing Address - Phone:805-497-8616
Mailing Address - Fax:805-496-5585
Practice Address - Street 1:3366 E THOUSAND OAKS BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-3443
Practice Address - Country:US
Practice Address - Phone:805-497-8616
Practice Address - Fax:805-496-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81184208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG08245Medicare UPIN
CAG08245Medicare UPIN