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Organization

THERAPEUTIC PAIN MANAGEMENT MEDICAL CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT HANSEN M.D. (MANG PARTNR)
5302462410410
Entity
Organization

Contact information

Practice address
1335 BUENAVENTURA BLVD, #100, REDDING, CA 96001-0160
(530) 241-0410
(530) 241-0472
Mailing address
3116 W MARCH LN, STE 200, STOCKTON, CA 95219-2369
(209) 473-6555
(209) 473-6543

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A043275
DE. DHRUVA'S MD LIC #
CA
01
A070414
DR IRANPUR MD LIC #
CA
01
G047619
DR HANSEN MD LIC #
CA
05
PENDING
CA
Enumeration date
05/16/2007
Last updated
03/03/2010
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