Provider Demographics
NPI:1225358609
Name:SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER, INC
Entity Type:Organization
Organization Name:SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-640-5555
Mailing Address - Street 1:3703 CAMINO DEL RIO S
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4031
Mailing Address - Country:US
Mailing Address - Phone:619-640-5555
Mailing Address - Fax:619-640-5550
Practice Address - Street 1:3703 CAMINO DEL RIO S
Practice Address - Street 2:STE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4031
Practice Address - Country:US
Practice Address - Phone:619-640-5106
Practice Address - Fax:619-640-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66777207LP2900X
2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty