Healthcare Provider Details

I. General information

NPI: 1376745497
Provider Name (Legal Business Name): CENTRAL PACIFIC PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PASEO CAMARILLO
CAMARILLO CA
93010
US

IV. Provider business mailing address

P.O. BOX 5457
SAN LUIS OBISPO CA
93403
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-8558
  • Fax: 805-484-3099
Mailing address:
  • Phone: 805-484-8558
  • Fax: 805-484-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DALE G KIKER
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 805-484-8558