Organization
INNOVATIVE PAIN MANAGEMENT MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENTON D WYNN M.D. (PRESIDENT)
(619) 434-4019
Entity
Organization
Contact information
Practice address
610 EUCLID AVE, SUITE 301, NATIONAL CITY, CA 91950-2951
(619) 434-4019
(619) 434-4023
Mailing address
333 W HARBOR DR, SUITE 126, SAN DIEGO, CA 92101-7709
(619) 434-4019
(619) 434-4023
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
A73257
CA
261QP3300X
Pain Clinic/Center
—
CA
Other
Enumeration date
04/13/2017
Last updated
04/13/2017
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