Provider Demographics
NPI:1508978099
Name:CORPUS CHRISTI PAIN MEDICINE, P.A.
Entity Type:Organization
Organization Name:CORPUS CHRISTI PAIN MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-658-9317
Mailing Address - Street 1:4833 SARATOGA BLVD
Mailing Address - Street 2:NO. 272
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2213
Mailing Address - Country:US
Mailing Address - Phone:361-658-9317
Mailing Address - Fax:361-853-0887
Practice Address - Street 1:3825 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2913
Practice Address - Country:US
Practice Address - Phone:361-225-0089
Practice Address - Fax:361-225-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI09621Medicare UPIN