Organization
COMMUNITY PAIN MANAGEMENT MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAN PAUL MADDOX M.D.,FIPP,ABA,ABPM (MEDICAL DIRECTOR)
(951) 715-3963
Entity
Organization
Contact information
Practice address
4500 BROCKTON AVE, STE 305, RIVERSIDE, CA 92501-4028
(951) 715-3963
(951) 715-3960
Mailing address
PO BOX 1509, RIVERSIDE, CA 92502-1509
(951) 715-3963
(951) 715-3960
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
A32046
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A320460
MEDI-CAL ID NUMBER
CA
01
—
ZZZ05981Z
BLUE SHIELD ID
CA
Enumeration date
06/15/2005
Last updated
04/20/2008
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