Provider Demographics
NPI:1104244029
Name:NOR CAL PAIN MANAGEMENT
Entity type:Organization
Organization Name:NOR CAL PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGUIZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-882-9832
Mailing Address - Street 1:5900 SHATTUCK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1461
Mailing Address - Country:US
Mailing Address - Phone:877-882-9832
Mailing Address - Fax:909-380-7741
Practice Address - Street 1:5900 SHATTUCK AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1461
Practice Address - Country:US
Practice Address - Phone:877-882-9832
Practice Address - Fax:909-380-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26628111NX0800X
CAPSY6247174400000X
CAA28494363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28494OtherLICENSE NUMBER