# REGIONAL PAIN TREATMENT CENTER

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

## Provider details

- **NPI number:** 1710305644
- **Authorized official:** CRIS MARQUEZ CANCHOLA (MANAGEMENT CONSULTANT)
- **Authorized official phone:** (858) 345-7260

## Contact information

- **Practice address:** 295 IMPERIAL HWY, SUITE 100, FULLERTON, CA 92835-1020
- **Practice address phone:** (858) 345-7260
- **Mailing address:** 295 IMPERIAL HWY, SUITE 100, FULLERTON, CA 92835-1020
- **Mailing address phone:** (858) 345-7260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | G59013 | CA | Yes |

## Other

- **Enumeration date:** 03/28/2014
- **Last updated:** 03/28/2014