Provider Demographics
NPI:1104018159
Name:CHARLES R STEVENS M.D, APC
Entity Type:Organization
Organization Name:CHARLES R STEVENS M.D, APC
Other - Org Name:ADVANCED PAIN ASSOCIATES, A.P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-482-0212
Mailing Address - Street 1:1665 S IMPERIAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4247
Mailing Address - Country:US
Mailing Address - Phone:760-482-0212
Mailing Address - Fax:760-482-0166
Practice Address - Street 1:1665 S IMPERIAL AVE STE D
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4247
Practice Address - Country:US
Practice Address - Phone:760-482-0212
Practice Address - Fax:760-482-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA104563OtherMEDICAL LICENSE
CABH832OtherMEDICARE
CABH832OtherMEDICARE