Healthcare Provider Details

I. General information

NPI: 1003261538
Provider Name (Legal Business Name): ZEN CENTER FOR PAIN MANAGEMENT & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 W REDLANDS BLVD STE 100
REDLANDS CA
92373-3118
US

IV. Provider business mailing address

1835 W REDLANDS BLVD STE 100
REDLANDS CA
92373-3118
US

V. Phone/Fax

Practice location:
  • Phone: 951-263-7202
  • Fax: 949-269-0672
Mailing address:
  • Phone: 951-263-7202
  • Fax: 949-269-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DINORA NAVA OLESON
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-263-7202