Provider Demographics
NPI:1144736174
Name:PAIN SOLUTIONS MEDICAL MASSAGE, INC.
Entity Type:Organization
Organization Name:PAIN SOLUTIONS MEDICAL MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:LA MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-347-0330
Mailing Address - Street 1:823 TRI CITY CTR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2859
Mailing Address - Country:US
Mailing Address - Phone:909-347-0330
Mailing Address - Fax:
Practice Address - Street 1:823 TRI CITY CTR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2859
Practice Address - Country:US
Practice Address - Phone:909-347-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty