Provider Demographics
NPI:1881295608
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:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAWNI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-640-5555
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?:Yes
Parent Organization LBN:SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty