Spinal Procedures Medical Group

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

A63617 Issued in CA

Legal business name

SPINAL PROCEDURES MEDICAL GROUP

Practice address

17525 Ventura Blvd
Ste 203
Encino, CA 91316-5109

Phone

(818) 986-0200

Fax

(818) 638-5762

NPI assigned

Jan 17, 2014

Last updated

Jan 17, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Payam Vahedifar, MD

Title

Owner and Physician

Phone

(818) 986-0200

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1992127468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17525 VENTURA BLVD",
            "address_2": "STE 203",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165109",
            "telephone_number": "818-986-0200",
            "fax_number": "818-638-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17525 VENTURA BLVD",
            "address_2": "STE 203",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165109",
            "telephone_number": "818-986-0200",
            "fax_number": "818-638-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINAL PROCEDURES MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-17",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "VAHEDIFAR",
        "authorized_official_first_name": "PAYAM",
        "authorized_official_title_or_position": "OWNER AND PHYSICIAN",
        "authorized_official_telephone_number": "818-986-0200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "CA",
            "license": "A63617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Clinic/Center in Encino, CA
• Providers in Encino, CA by specialty
• Pain Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.