Healthcare Provider Details

I. General information

NPI: 1770292807
Provider Name (Legal Business Name): SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 W MAIN ST
EL CENTRO CA
92243-2920
US

IV. Provider business mailing address

3703 CAMINO DEL RIO S STE 210
SAN DIEGO CA
92108-4033
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-5931
  • Fax: 760-482-5936
Mailing address:
  • Phone: 619-640-5555
  • Fax: 619-640-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID J SMITH
Title or Position: OWNER
Credential: MD
Phone: 619-640-5555