# INNOVATIVE PAIN MANAGEMENT MEDICAL GROUP

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

## Provider details

- **NPI number:** 1902330285
- **Authorized official:** BRENTON D WYNN M.D. (PRESIDENT)
- **Authorized official phone:** (619) 434-4019

## Contact information

- **Practice address:** 610 EUCLID AVE, SUITE 301, NATIONAL CITY, CA 91950-2951
- **Practice address phone:** (619) 434-4019
- **Practice address fax:** (619) 434-4023
- **Mailing address:** 333 W HARBOR DR, SUITE 126, SAN DIEGO, CA 92101-7709
- **Mailing address phone:** (619) 434-4019
- **Mailing address fax:** (619) 434-4023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | A73257 | CA | Yes |
| 261QP3300X | Pain Clinic/Center | — | CA | — |

## Other

- **Enumeration date:** 04/13/2017
- **Last updated:** 04/13/2017