Organization
JP ANESTHESIOLOGY, INC
Active
Other names
Advanced Pain Management Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOE PARK M.D. (PRESIDENT)
(760) 843-9679
Entity
Organization
Contact information
Practice address
15447 W SAND ST, VICTORVILLE, CA 92392-2904
(760) 843-9679
(760) 245-3618
Mailing address
15447 WEST SAND STREET, VICTORVILLE, CA 92392-4500
(760) 843-9679
(760) 245-3618
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
A86588
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A865880
—
CA
01
—
DF4286
MEDICARE RAILROAD
CA
01
—
ZZZ02746Z
PTAN
CA
Enumeration date
10/10/2006
Last updated
03/07/2023
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