Provider Demographics
NPI:1629738737
Name:EL CENTRO COMPREHENSIVE PAIN MANAGEMENT INC
Entity Type:Organization
Organization Name:EL CENTRO COMPREHENSIVE PAIN MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:LOTES
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-282-0216
Mailing Address - Street 1:1575 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2211
Mailing Address - Country:US
Mailing Address - Phone:760-482-5931
Mailing Address - Fax:760-482-5936
Practice Address - Street 1:1575 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2211
Practice Address - Country:US
Practice Address - Phone:760-482-5931
Practice Address - Fax:760-482-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies