# PAIN AND REHABILITATION MEDICAL GROUP, A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720183973
- **Authorized official:** FABIAN A PROANO MD (PRESIDENT)
- **Authorized official phone:** (310) 791-4980

## Contact information

- **Practice address:** 3655 LOMITA BLVD STE 206, TORRANCE, CA 90505-1930
- **Practice address phone:** (310) 791-4980
- **Practice address fax:** (310) 791-4989
- **Mailing address:** 3655 LOMITA BLVD STE 206, TORRANCE, CA 90505-1930
- **Mailing address phone:** (310) 791-4980
- **Mailing address fax:** (310) 791-4989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | G55631 | CA | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | G60934 | CA | — |
| 2084P2900X | Pain Medicine (Psychiatry & Neurology) Physician | PSY4695 | CA | — |

## Other

- **Enumeration date:** 09/13/2006
- **Last updated:** 11/21/2024