Basic Information
| Provider Information | |||||||||
| NPI: | 1043605777 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTLEY PAIN SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7525 METROPOLITAN DR | ||||||||
| Address2: | STE 302 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193251161 | ||||||||
| FaxNumber: | 6193251717 | ||||||||
| Practice Location | |||||||||
| Address1: | 7525 METROPOLITAN DR | ||||||||
| Address2: | STE 302 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193251161 | ||||||||
| FaxNumber: | 6193251717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | BURK | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6193251161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 52242 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.