Organization
PAIN DIAGNOSIS & TREATMENT INC., A MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRI WICKMAN (BILLER)
(626) 857-7400
Entity
Organization
Contact information
Practice address
10630 DOWNEY AVE, SUITE 102, DOWNEY, CA 90241-3463
(562) 861-5170
Mailing address
210 S GRAND AVE, SUITE 315, GLENDORA, CA 91741-4205
(626) 857-7400
(626) 857-7404
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
A020970
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
A43746
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A437461
—
CA
Enumeration date
12/06/2007
Last updated
01/12/2011
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