Provider Demographics
NPI:1134151236
Name:ALPHA PAIN MANAGEMENT A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALPHA PAIN MANAGEMENT A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:EMENIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-694-0385
Mailing Address - Street 1:11693 SAN VICENTE BLVD # 112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5105
Mailing Address - Country:US
Mailing Address - Phone:310-694-0385
Mailing Address - Fax:
Practice Address - Street 1:4954 VAN NUYS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1798
Practice Address - Country:US
Practice Address - Phone:310-694-0385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92212208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134151236Medicaid