Provider Demographics
NPI:1497888382
Name:CENTRAL VALLEY PAIN MANAGEMENT & WELLNESS INC.
Entity Type:Organization
Organization Name:CENTRAL VALLEY PAIN MANAGEMENT & WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:209-571-1992
Mailing Address - Street 1:1300 MABLE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1120
Mailing Address - Country:US
Mailing Address - Phone:209-571-1992
Mailing Address - Fax:209-571-1994
Practice Address - Street 1:1300 MABLE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1120
Practice Address - Country:US
Practice Address - Phone:209-571-1992
Practice Address - Fax:209-571-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14435204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty