Basic Information
| Provider Information | |||||||||
| NPI: | 1013478130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PAIN MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7230 MEDICAL CENTER DR STE 500 | ||||||||
| Address2: | |||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913074024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 W AVENUE Q STE B | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935513894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2019 | ||||||||
| LastUpdateDate: | 03/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | SARIAN | ||||||||
| AuthorizedOfficialFirstName: | JACKIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8183487246 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVANCED PAIN MEDICAL GROUP, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 208VP0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.