Basic Information
| Provider Information | |||||||||
| NPI: | 1356795157 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN ALLEVIA MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 501724 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921501724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584537700 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Practice Location | |||||||||
| Address1: | 16466 BERNARDO CENTER DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921282522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584537700 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2016 | ||||||||
| LastUpdateDate: | 04/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | CHONG | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8584537700 | ||||||||
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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 | 2081P2900X | A103353 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.