Basic Information
| Provider Information | |||||||||
| NPI: | 1053659995 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN ALLEVIA MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5333 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905105333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147772469 | ||||||||
| FaxNumber: | 7147772427 | ||||||||
| Practice Location | |||||||||
| Address1: | 15611 POMERADO RD | ||||||||
| Address2: | SUITE 525 | ||||||||
| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920642437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586136252 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHONG | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8083920512 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | A103353 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.