Basic Information
| Provider Information | |||||||||
| NPI: | 1801831631 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERVENTIONAL PAIN SPECIALISTS OF SO CA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 969096 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921969096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584950971 | ||||||||
| FaxNumber: | 8584950991 | ||||||||
| Practice Location | |||||||||
| Address1: | 7485 MISSION VALLEY RD | ||||||||
| Address2: | STE 104B | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192991767 | ||||||||
| FaxNumber: | 6192990925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6192991767 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.