Provider Demographics
NPI:1225123227
Name:COMPREHENSIVE PAIN MANAGEMENT CENTER, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUELAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA, RN, CRT
Authorized Official - Phone:559-447-4898
Mailing Address - Street 1:7152 N SHARON #104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-447-4898
Mailing Address - Fax:559-447-4915
Practice Address - Street 1:7152 N SHARON #104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-447-4898
Practice Address - Fax:559-447-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAS1507261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21108ZMedicare ID - Type UnspecifiedFACILITY