Provider Demographics
NPI:1952437261
Name:PAINMD MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:PAINMD MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-8959
Mailing Address - Street 1:665 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2859
Mailing Address - Country:US
Mailing Address - Phone:949-364-8959
Mailing Address - Fax:
Practice Address - Street 1:665 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2859
Practice Address - Country:US
Practice Address - Phone:949-364-8959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA029370208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18001Medicare PIN
CADE8290Medicare PIN