Provider Demographics
NPI:1245876937
Name:DTLA PAIN SURGERY CENTER INC
Entity type:Organization
Organization Name:DTLA PAIN SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BADDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-872-2633
Mailing Address - Street 1:5 HOLLAND
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2568
Mailing Address - Country:US
Mailing Address - Phone:949-588-2190
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:1513 S GRAND AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3070
Practice Address - Country:US
Practice Address - Phone:949-872-2633
Practice Address - Fax:888-885-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669470068Medicaid
CA1437700465OtherASC