Provider Demographics
NPI:1972724987
Name:AMERICAN PAIN INSTITUE SURGICAL MEDICAL CENTER INC
Entity type:Organization
Organization Name:AMERICAN PAIN INSTITUE SURGICAL MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-279-1855
Mailing Address - Street 1:10610 LOWER AZUSA RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1210
Mailing Address - Country:US
Mailing Address - Phone:626-279-1855
Mailing Address - Fax:626-279-9455
Practice Address - Street 1:10610 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1210
Practice Address - Country:US
Practice Address - Phone:626-279-1855
Practice Address - Fax:626-279-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMQ 10174261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP 31042OtherFICTITIOUS NAME PERMIT
CAIMQ ACCREDITATIONOther10174
CA18948OtherCITY BUSINESS LICENSE