Healthcare Provider Details

I. General information

NPI: 1942400692
Provider Name (Legal Business Name): CPMS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16466 BERNARDO CENTER DR STE 150
SAN DIEGO CA
92128-2522
US

IV. Provider business mailing address

PO BOX 501724
SAN DIEGO CA
92150-1724
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-7000
  • Fax: 858-798-1225
Mailing address:
  • Phone: 584-537-7008
  • Fax: 858-798-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA86646
License Number StateCA

VIII. Authorized Official

Name: MISS NACOLE PARKER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 858-453-7700