Provider Demographics
NPI:1437234390
Name:CENTRAL CALIFORNIA ANESTHESIA & PAIN MANAGEMENT ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL CALIFORNIA ANESTHESIA & PAIN MANAGEMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHONG
Authorized Official - Middle Name:H
Authorized Official - Last Name:NICHOLLS
Authorized Official - Suffix:
Authorized Official - Credentials:MDA
Authorized Official - Phone:209-345-1193
Mailing Address - Street 1:3000 S JAMAICA CT STE 140
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4601
Mailing Address - Country:US
Mailing Address - Phone:303-755-3508
Mailing Address - Fax:
Practice Address - Street 1:3850 GREER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-345-1193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF72682Medicare ID - Type Unspecified