Basic Information
| Provider Information | |||||||||
| NPI: | 1891818951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PAIN MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7230 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE #500 | ||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913071907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Practice Location | |||||||||
| Address1: | 7230 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE #500 | ||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913071907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 05/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | LALA | ||||||||
| AuthorizedOfficialFirstName: | VIMAL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8183487246 | ||||||||
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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 | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.