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Organization
PAIN MANAGEMENT SPECIALISTS MEDICAL GROUP
Active
Organization
PAIN MANAGEMENT SPECIALISTS MEDICAL GROUP
Active
Other names
interventional pain management
Organization subpart
No
Provider details
NPI number
Authorized official
MS. INNA GRIBANOVA (MANAGER)
(805) 782-8132
Entity
Organization
Contact information
Practice address
10 SANTA ROSA ST, STE 201, SAN LUIS OBISPO, CA 93405-5825
(805) 782-8132
(805) 597-8350
Mailing address
PO BOX 4659, SAN LUIS OBISPO, CA 93403-4659
(805) 782-8132
(805) 597-8350
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0105740
—
CA
Enumeration date
05/23/2005
Last updated
12/29/2010
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