Provider Demographics
NPI:1689955254
Name:CALIFORNIA PAIN REHABILITATION INSTITUTE
Entity Type:Organization
Organization Name:CALIFORNIA PAIN REHABILITATION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:R
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:559-435-3696
Mailing Address - Street 1:PO BOX 27588
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7588
Mailing Address - Country:US
Mailing Address - Phone:559-435-3696
Mailing Address - Fax:559-435-3698
Practice Address - Street 1:2848 MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1308
Practice Address - Country:US
Practice Address - Phone:559-435-3696
Practice Address - Fax:559-435-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty