Basic Information
| Provider Information | |||||||||
| NPI: | 1942400692 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CPMS MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 501724 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921501724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5845377008 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Practice Location | |||||||||
| Address1: | 16466 BERNARDO CENTER DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921282522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584537000 | ||||||||
| FaxNumber: | 8587981225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2007 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | PARKER | ||||||||
| AuthorizedOfficialFirstName: | NACOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8584537700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | A86646 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.