Provider Demographics
NPI:1538342357
Name:THERAPEUTIC PAIN MANAGEMENT
Entity type:Organization
Organization Name:THERAPEUTIC PAIN MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-323-7246
Mailing Address - Street 1:6929 N WILLOW AVE
Mailing Address - Street 2:STE #103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5956
Mailing Address - Country:US
Mailing Address - Phone:559-323-7246
Mailing Address - Fax:559-323-7271
Practice Address - Street 1:6929 N WILLOW AVE
Practice Address - Street 2:STE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5956
Practice Address - Country:US
Practice Address - Phone:559-323-7246
Practice Address - Fax:559-323-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53036332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19253/19150OtherCA STATE EXEMPTEE LICENSE
CA53036OtherDMEPOS RETAILER
CA1538342357Medicaid
CAS11165OtherACCREDIDATION-BOARD OF ORTHOTICS AND PROSTHETICS
CA6104050002Medicare NSC