Healthcare Provider Details

I. General information

NPI: 1184260242
Provider Name (Legal Business Name): CALIFORNIA PAIN RELIEF GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 IMPERIAL HWY STE 100
FULLERTON CA
92835-1020
US

IV. Provider business mailing address

504 N REO ST
TAMPA FL
33609-1013
US

V. Phone/Fax

Practice location:
  • Phone: 888-311-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RODOLFO GARI
Title or Position: FOUNDER
Credential: MD
Phone: 813-549-2134