Provider Demographics
NPI:1013268069
Name:SOUTHERN CALIFORNIA PAIN CONSULTANTS INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA PAIN CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STERLING
Authorized Official - Last Name:BRADLEY, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-9888
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-8129
Mailing Address - Country:US
Mailing Address - Phone:310-540-9888
Mailing Address - Fax:310-540-0444
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 590
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4536
Practice Address - Country:US
Practice Address - Phone:310-540-9888
Practice Address - Fax:310-540-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82005207L00000X, 208VP0014X
CAA1090162084P0800X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty