MEDICARE: SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER, 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	261QP3300X	Pain Clinic/Center
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1770292807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO COMPREHENSIVE PAIN MANAGEMENT CENTER, INC

Provider Business Mailing Address
First Line	:	3703 CAMINO DEL RIO S STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4033
Country	:	US
Telephone Number	:	619-640-5555
Fax Number	:	619-640-5550

Provider Business Practice Location Address
First Line	:	626 W MAIN ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2920
Country	:	US
Telephone Number	:	760-482-5931
Fax Number	:	760-482-5936

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID J SMITH
Credential	:	MD
Telephone Number	:	619-640-5555

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	11/17/2022

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