Provider Demographics
NPI:1093885675
Name:RANCHO MIRAGE PAIN CENTER INC
Entity Type:Organization
Organization Name:RANCHO MIRAGE PAIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ERLENDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-773-3075
Mailing Address - Street 1:PO BOX 11918
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-1918
Mailing Address - Country:US
Mailing Address - Phone:714-824-8840
Mailing Address - Fax:714-824-8850
Practice Address - Street 1:39300 BOB HOPE DR
Practice Address - Street 2:BANNAN BUILDING, SUITE 1203
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3203
Practice Address - Country:US
Practice Address - Phone:760-773-3075
Practice Address - Fax:760-773-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50577261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG50577OtherSTATE MEDICAL LICENSE
CARHC137647OtherDEPT HEALTH SERV X-RAY
CARHC137647OtherDEPT HEALTH SERV X-RAY
CARHC137647OtherDEPT HEALTH SERV X-RAY