Basic Information
| Provider Information | |||||||||
| NPI: | 1780077230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CPMS MEDICAL GROUP | ||||||||
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| OtherOrganizationName: | COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 501724 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921501724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584537700 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Practice Location | |||||||||
| Address1: | 4510 EXECUTIVE DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921213023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584537700 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2015 | ||||||||
| LastUpdateDate: | 03/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | PARKER | ||||||||
| AuthorizedOfficialFirstName: | NICCI | ||||||||
| AuthorizedOfficialMiddleName: | JAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8584537700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | A103353 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 207LP2900X | A86646 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.