# CENTRAL VALLEY PAIN MANAGEMENT AND WELLNESS CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497134969
- **Authorized official:** ARIANA BEDOYA (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (813) 448-3848

## Contact information

- **Practice address:** 1300 MABLE AVE \# SUITEB2, MODESTO, CA 95355-1120
- **Practice address phone:** (813) 448-3848
- **Mailing address:** 311 PARK PLACE BLVD FL 5, CLEARWATER, FL 33759-4904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A51949 | CA | Yes |

## Other

- **Enumeration date:** 05/29/2015
- **Last updated:** 05/29/2015