Provider Demographics
NPI:1275579195
Name:REGIONAL PAIN TREATMENT MEDICAL CENTER INC
Entity Type:Organization
Organization Name:REGIONAL PAIN TREATMENT MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-549-2134
Mailing Address - Street 1:PO BOX 947831
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7831
Mailing Address - Country:US
Mailing Address - Phone:714-770-8300
Mailing Address - Fax:714-770-8311
Practice Address - Street 1:295 IMPERIAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1020
Practice Address - Country:US
Practice Address - Phone:714-770-8300
Practice Address - Fax:714-770-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59013208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275579195Medicaid