Healthcare Provider Details

I. General information

NPI: 1699891184
Provider Name (Legal Business Name): BRANDON VALINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # MC7651 UCSD MEDICAL CENTER FOR PAIN MEDICINE
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

2378 FENTON PKWY APT 212
SAN DIEGO CA
92108-4787
US

V. Phone/Fax

Practice location:
  • Phone: 619-929-8686
  • Fax:
Mailing address:
  • Phone: 619-929-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA111512
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA111512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: