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General NPI Number Information
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NPI Number | 1730286600
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Entity Type | Organization
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Legal Business Name | RANCHO MIRAGE PAIN ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 39300 BOB HOPE DR BANNAN BUILDING, SUITE 1203
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-3203
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Country | US
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Telephone | 760-773-3075
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Fax | 760-773-3091
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Provider Business Mailing Address
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Address Line | PO BOX 11918
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City | SANTA ANA
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State | CA
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Zip | 92711-1918
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Country | US
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Telephone | 714-824-8840
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Fax | 714-824-8850
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEE W. ERLENDSON
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Credential | M.D.
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Telephone | 760-773-3075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G50577
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G50577
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License Number State | CA
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