Provider Demographics
NPI:1528799657
Name:ADVANCED PAIN AND NEUROLOGY, LLC
Entity type:Organization
Organization Name:ADVANCED PAIN AND NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-433-4493
Mailing Address - Street 1:3911 4TH ST NW STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2510
Mailing Address - Country:US
Mailing Address - Phone:505-361-1931
Mailing Address - Fax:505-521-5147
Practice Address - Street 1:3911 4TH ST NW STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2510
Practice Address - Country:US
Practice Address - Phone:505-361-1931
Practice Address - Fax:505-521-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty