Provider Demographics
NPI:1154631943
Name:RANCHO MIRAGE PAIN MANAGEMENT INC
Entity Type:Organization
Organization Name:RANCHO MIRAGE PAIN MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON M.D
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-202-1919
Mailing Address - Street 1:P.O. BOX 3023
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1092
Mailing Address - Country:US
Mailing Address - Phone:760-202-1919
Mailing Address - Fax:760-202-1982
Practice Address - Street 1:71780 SAN JACINTO DRIVE
Practice Address - Street 2:SUITE 83
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1092
Practice Address - Country:US
Practice Address - Phone:760-202-1919
Practice Address - Fax:760-202-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG061216261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain