Provider Demographics
NPI:1902941271
Name:PAIN & ADDICTION MEDICINE ASSOC. OF SO CAL
Entity Type:Organization
Organization Name:PAIN & ADDICTION MEDICINE ASSOC. OF SO CAL
Other - Org Name:VADIM LIPEL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, CEO
Authorized Official - Phone:818-906-7643
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:STE 309
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2203
Mailing Address - Country:US
Mailing Address - Phone:818-906-7643
Mailing Address - Fax:818-906-7641
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:STE 309
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-906-7643
Practice Address - Fax:818-906-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty