Provider Demographics
NPI:1306117429
Name:HEMET PAIN MANAGEMENT CENTER, LLC
Entity type:Organization
Organization Name:HEMET PAIN MANAGEMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CICERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-699-0303
Mailing Address - Street 1:PO BOX 893520
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-3520
Mailing Address - Country:US
Mailing Address - Phone:951-699-0303
Mailing Address - Fax:951-296-3531
Practice Address - Street 1:162 N SANTA FE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4451
Practice Address - Country:US
Practice Address - Phone:951-506-9522
Practice Address - Fax:951-925-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty