Provider Demographics
NPI:1073104725
Name:CENTER FOR PAIN AND REHABILITATION INC
Entity type:Organization
Organization Name:CENTER FOR PAIN AND REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-806-0757
Mailing Address - Street 1:100 PARK PL # 120
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4460
Mailing Address - Country:US
Mailing Address - Phone:925-806-0757
Mailing Address - Fax:
Practice Address - Street 1:100 PARK PL # 120
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4460
Practice Address - Country:US
Practice Address - Phone:925-806-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty