MEDICARE: INTEGRATED PAIN SPECIALISTS OF SOUTHERN CALIFORNIA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G70647	OTHER	CA	PHYSICIAN MEDICAL LICENSE

General Provider Information

NPI Number	:	1639184344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED PAIN SPECIALISTS OF SOUTHERN CALIFORNIA, INC.

Provider Business Mailing Address
First Line	:	7525 LINDA VISTA RD STE C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5344
Country	:	US
Telephone Number	:	619-398-2988
Fax Number	:	619-398-2987

Provider Business Practice Location Address
First Line	:	7525 LINDA VISTA RD STE C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5344
Country	:	US
Telephone Number	:	619-398-2988
Fax Number	:	619-398-2987

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN S SMITH
Credential	:	MD
Telephone Number	:	619-398-2988

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	01/03/2024

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