Organization
PAIN DIAGNOSTIC AND TREATMENT CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (OFFICER, AUTHORIZED OFFICIAL)
(480) 567-0269
Entity
Organization
Contact information
Practice address
2805 J. ST, STE 200, SACRAMENTO, CA 95816-4307
(916) 462-9800
(916) 462-9801
Mailing address
2805 J. ST, STE 200, SACRAMENTO, CA 95816-4307
(916) 462-9800
(916) 462-9801
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
030000705
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0153037
STATE OF WA DEPT OF LABOR
CA
01
—
184315700
US DEPT OF LABOR
CA
01
—
490004875
RAILROAD MEDICARE
CA
05
—
SUR01481F
—
CA
01
—
ZZZH3417A
BLUE SHIELD OF CA
CA
Enumeration date
06/15/2005
Last updated
11/07/2025
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