Basic Information
| Provider Information | |||||||||
| NPI: | 1235374372 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MISSION HILLS PAIN MANAGEMENT MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 515804 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900513104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094933800 | ||||||||
| FaxNumber: | 9092047868 | ||||||||
| Practice Location | |||||||||
| Address1: | 19871 NORDHOFF ST | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913243331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183598833 | ||||||||
| FaxNumber: | 8777279225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2008 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | ARFAI | ||||||||
| AuthorizedOfficialFirstName: | KIUMARS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8183598833 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | 0002402666-0001-2 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 261QP3300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.