Provider Demographics
NPI:1871931238
Name:ARROYO VISTA ADVANCED PAIN SPECIALISTS, INC
Entity type:Organization
Organization Name:ARROYO VISTA ADVANCED PAIN SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA LOUIE
Authorized Official - Middle Name:ALVAREZ
Authorized Official - Last Name:WANIA-GALICIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-222-4549
Mailing Address - Street 1:530 W LOS ANGELES AVE STE 115
Mailing Address - Street 2:MS-343
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1746
Mailing Address - Country:US
Mailing Address - Phone:805-222-4549
Mailing Address - Fax:805-529-4549
Practice Address - Street 1:865 PATRIOT DR
Practice Address - Street 2:STE 201A
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3405
Practice Address - Country:US
Practice Address - Phone:805-222-4549
Practice Address - Fax:805-529-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty