Healthcare Provider Details

I. General information

NPI: 1952437261
Provider Name (Legal Business Name): PAINMD MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CAMINO DE LOS MARES SUITE 202
SAN CLEMENTE CA
92673-2859
US

IV. Provider business mailing address

665 CAMINO DE LOS MARES SUITE 202
SAN CLEMENTE CA
92673-2859
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-8959
  • Fax:
Mailing address:
  • Phone: 949-364-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number029370
License Number StateCA

VIII. Authorized Official

Name: DR. ANDRES BETTS
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 949-364-8959