Healthcare Provider Details

I. General information

NPI: 1306117429
Provider Name (Legal Business Name): HEMET PAIN MANAGEMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 N SANTA FE ST
HEMET CA
92543-4451
US

IV. Provider business mailing address

PO BOX 893520
TEMECULA CA
92589-3520
US

V. Phone/Fax

Practice location:
  • Phone: 951-506-9522
  • Fax: 951-925-5905
Mailing address:
  • Phone: 951-699-0303
  • Fax: 951-296-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEXIS CICERO
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 951-699-0303