1437349578 NPI number — PAIN CONTROL ASSOCIATES OF SAN DIEGO, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437349578 NPI number — PAIN CONTROL ASSOCIATES OF SAN DIEGO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN CONTROL ASSOCIATES OF SAN DIEGO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437349578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2452 FENTON ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91914-3599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-271-1683
Provider Business Mailing Address Fax Number:
619-651-7033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2452 FENTON ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91914-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-271-1683
Provider Business Practice Location Address Fax Number:
619-651-7033
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VERDOLIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-271-1683

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  A 92149 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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