Organization
COMMUNITY PAIN MANAGEMENT MEDICAL CLINIC INC
Active
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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