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General NPI Number Information
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NPI Number | 1841683984
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Entity Type | Organization
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Legal Business Name | PAIN RECOVERY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 34085 PACIFIC COAST HWY #203
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City | DANA POINT
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State | CA
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Zip | 92629-2764
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Country | US
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Telephone | 714-377-3749
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Fax | 714-377-5642
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Provider Business Mailing Address
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Address Line | PO BOX 6747
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92615-6747
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Country | US
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Telephone | 714-377-3749
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Fax | 714-377-5642
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | RENEE FULLER
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Credential |
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Telephone | 562-308-0461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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