Provider Demographics
NPI:1295254050
Name:GLENDALE BACK AND PAIN CENTER
Entity type:Organization
Organization Name:GLENDALE BACK AND PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHAVARZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-637-8363
Mailing Address - Street 1:350 N. GLENDALE AVE
Mailing Address - Street 2:SUITE B-504
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206
Mailing Address - Country:US
Mailing Address - Phone:844-566-7246
Mailing Address - Fax:844-637-8332
Practice Address - Street 1:710 S. CENTRAL AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:844-566-7246
Practice Address - Fax:844-637-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty