MEDICARE: RANCHO MIRAGE PAIN ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	G50577	CA
2	207L00000X	Anesthesiology Physician	G50577	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G50577	OTHER	CA	STATE MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730286600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO MIRAGE PAIN ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 11918
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92711-1918
Country	:	US
Telephone Number	:	714-824-8840
Fax Number	:	714-824-8850

Provider Business Practice Location Address
First Line	:	39300 BOB HOPE DR
Second Line	:	BANNAN BUILDING, SUITE 1203
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-3203
Country	:	US
Telephone Number	:	760-773-3075
Fax Number	:	760-773-3091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEE W. ERLENDSON
Credential	:	M.D.
Telephone Number	:	760-773-3075

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/07/2023

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Directions to “RANCHO MIRAGE PAIN ASSOCIATES, INC. ” Practice Location

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