Basic Information
| Provider Information | |||||||||
| NPI: | 1649440991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AXIOM PAIN MANAGEMENT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 788 | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925460788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519296260 | ||||||||
| FaxNumber: | 9517652855 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924111233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098800536 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2008 | ||||||||
| LastUpdateDate: | 03/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | AVILA | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9519296260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 20A8829 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.