Provider Demographics
NPI:1770292807
Name:SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER, INC
Entity type:Organization
Organization Name:SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-640-5555
Mailing Address - Street 1:3703 CAMINO DEL RIO S STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4033
Mailing Address - Country:US
Mailing Address - Phone:619-640-5555
Mailing Address - Fax:619-640-5550
Practice Address - Street 1:626 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2920
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:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty