Provider Demographics
NPI:1104153931
Name:ENCINO PLACE PAIN MANAGEMENT AND SURGERY CENTER INC
Entity type:Organization
Organization Name:ENCINO PLACE PAIN MANAGEMENT AND SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUBHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-366-0474
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-8000
Mailing Address - Country:US
Mailing Address - Phone:818-802-3514
Mailing Address - Fax:818-462-9035
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUITE # 240
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2500
Practice Address - Country:US
Practice Address - Phone:818-357-5529
Practice Address - Fax:818-462-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical