Healthcare Provider Details

I. General information

NPI: 1942335468
Provider Name (Legal Business Name): INNOVATIVE PAIN TREATMENT SURGERY CENTER OF TEMECULA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27412 ENTERPRISE CIR W SUITE 100
TEMECULA CA
92590-4803
US

IV. Provider business mailing address

27412 ENTERPRISE CIR W STE 100
TEMECULA CA
92590-4801
US

V. Phone/Fax

Practice location:
  • Phone: 951-694-6367
  • Fax: 951-694-1428
Mailing address:
  • Phone: 951-694-6367
  • Fax: 951-694-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AUTUMN ELAINE VILLEGAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 951-694-6367