Provider Demographics
NPI:1013021641
Name:PAIN AND REHABILITATION TECHNOLOGIES
Entity Type:Organization
Organization Name:PAIN AND REHABILITATION TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THUDIUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-794-3145
Mailing Address - Street 1:8400 MIRAMAR RD STE 203A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4387
Mailing Address - Country:US
Mailing Address - Phone:619-794-3145
Mailing Address - Fax:
Practice Address - Street 1:8400 MIRAMAR RD STE 203A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4387
Practice Address - Country:US
Practice Address - Phone:619-704-0550
Practice Address - Fax:619-695-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5685170001Medicare NSC