Organization
CENTRAL VALLEY PAIN MANAGEMENT AND WELLNESS CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARIANA BEDOYA (CREDENTIALING SPECIALIST)
(813) 448-3848
Entity
Organization
Contact information
Practice address
1300 MABLE AVE # SUITEB2, MODESTO, CA 95355-1120
(813) 448-3848
Mailing address
311 PARK PLACE BLVD FL 5, CLEARWATER, FL 33759-4904
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A51949
CA
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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