COMMUNITY PAIN MANAGEMENT MEDICAL CLINIC INC
Psychiatric at Brockton Ave, Riverside, CA

License number
California A32046
Category
Psychiatric
Type
Interventional Pain Medicine
Owner
Name: DR. JAN PAUL MADDOX M.D.,FIPP,ABA,ABPM
Title: MEDICAL DIRECTOR
Phone: (951) 715-3963
Address
Address
4500 Brockton Ave STE 305, Riverside, CA 92501
National Provider ID: 1811992068
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Community Pain Management Medical Clinic, Inc

Riverside, CA

Status:
Inactive
Registration:
Mar 9, 1999
Phone:
(951) 715-3963 (Phone)
Addresses:
1737 Cyn Hl Dr, Riverside, CA 92506
4500 Brockton Ave, Riverside, CA 92501
State ID:
C2156359
Business type:
Articles of Incorporation
Presidents:
Jan P. Moddox President, inactive,Jan Maddox President, inactive
Agent:
Jan P Maddox,Riverside, CA 92506 (Physical)

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