Healthcare Provider Details

I. General information

NPI: 1730286600
Provider Name (Legal Business Name): RANCHO MIRAGE PAIN ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39300 BOB HOPE DR BANNAN BUILDING, SUITE 1203
RANCHO MIRAGE CA
92270-3203
US

IV. Provider business mailing address

PO BOX 11918
SANTA ANA CA
92711-1918
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-3075
  • Fax: 760-773-3091
Mailing address:
  • Phone: 714-824-8840
  • Fax: 714-824-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG50577
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG50577
License Number StateCA

VIII. Authorized Official

Name: LEE W. ERLENDSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-773-3075