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SAN DIMAS PAIN MANAGEMENT MEDICAL CENTER INC. NPI 1124004114


NPI Information

NPI: 1124004114
Provider Name: SAN DIMAS PAIN MANAGEMENT MEDICAL CENTER INC.
Classification: Pain Medicine - 208VP0014X
Entity Type: Organization

Specialization: Interventional Pain Medicine

CLIA Number: 05D2012389

Address:
125 WHEELER AVE
SUITE C
ARCADIA, CA
ZIP 91006
Phone: (626) 294-4866
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SAN DIMAS PAIN MANAGEMENT MEDICAL CENTER INC. is an interventional pain medicine pain medicine in Arcadia, CA. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. SAN DIMAS PAIN MANAGEMENT MEDICAL CENTER INC. NPI is 1124004114. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

125 WHEELER AVE
SUITE C
ARCADIA, CA
ZIP 91006-220
Phone: (626) 294-4866
Fax: (626) 294-4872

The provider's authorized official is Bernadette A Clifford .
The authorized official title is Chief Operating Officer and has the following contact phone number (626) 294-4866.

The CLIA number assigned to this NPI record is 05D2012389 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/21/2005 and was last updated on 6/28/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208VP0014XPain MedicineInterventional Pain MedicineA53113CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1F89498MEDICARE UPIN
2W14408MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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