Basic Information
| Provider Information | |||||||||
| NPI: | 1578199147 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE PAIN & REGENERATIVE MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26051 RED CORRAL RD | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926536310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492903972 | ||||||||
| FaxNumber: | 5627868613 | ||||||||
| Practice Location | |||||||||
| Address1: | 24452 HEALTH CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492903972 | ||||||||
| FaxNumber: | 5627868613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2020 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | JORGE | ||||||||
| AuthorizedOfficialFirstName: | PAOLO | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9492903972 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.