Basic Information
| Provider Information | |||||||||
| NPI: | 1457647117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERDOLIN PAIN SPECIALISTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 891 KUHN DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919143551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197615308 | ||||||||
| FaxNumber: | 6197523968 | ||||||||
| Practice Location | |||||||||
| Address1: | 891 KUHN DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919143551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197615308 | ||||||||
| FaxNumber: | 6197523968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2011 | ||||||||
| LastUpdateDate: | 09/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | VERDOLIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6192136665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A92149 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | A92149 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | A92149 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.