Provider Demographics
NPI:1992943666
Name:PACIFIC PAIN CONTROL CLINIC
Entity type:Organization
Organization Name:PACIFIC PAIN CONTROL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-522-2001
Mailing Address - Street 1:7439 LA PALMA AVE
Mailing Address - Street 2:# 120
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2698
Mailing Address - Country:US
Mailing Address - Phone:714-522-2001
Mailing Address - Fax:714-522-7503
Practice Address - Street 1:9201 W SUNSET BLVS
Practice Address - Street 2:# 612
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:714-522-2001
Practice Address - Fax:714-522-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP21284261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42539Medicare PIN