Provider Demographics
NPI:1174926299
Name:PAIN REHABILITATION INSTITUTE, INC.
Entity type:Organization
Organization Name:PAIN REHABILITATION INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PACITO
Authorized Official - Middle Name:VER
Authorized Official - Last Name:YABES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-258-3528
Mailing Address - Street 1:1705 BARONESS WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5029
Mailing Address - Country:US
Mailing Address - Phone:916-258-3528
Mailing Address - Fax:
Practice Address - Street 1:1705 BARONESS WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5029
Practice Address - Country:US
Practice Address - Phone:916-865-4323
Practice Address - Fax:916-749-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83769208100000X
208100000X, 2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty