Southwest Comprehensive Pain Management LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

32912 Issued in AZ

Legal business name

SOUTHWEST COMPREHENSIVE PAIN MANAGEMENT LLC

Practice address

1749 W Bramble Berry LN
Phoenix, AZ 85085-8044

Phone

(623) 780-1563

NPI assigned

May 14, 2008

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gabriel Luis Bonilla, MDNPI 1023080744

Title

Medical Director and LLC Member

Phone

(623) 780-1563

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gabriel L Bonilla, MD

  • Physical Medicine & Rehabilitation Physician
  • Phoenix, AZ
  • NPI 1023080744
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1316114663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1749 W BRAMBLE BERRY LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850858044",
            "telephone_number": "623-780-1563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 W BRAMBLE BERRY LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850858044",
            "telephone_number": "623-780-1563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST COMPREHENSIVE PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BONILLA",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR AND LLC MEMBER",
        "authorized_official_telephone_number": "623-780-1563",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "AZ",
            "license": "32912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pain Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.