Healthcare Provider Details

I. General information

NPI: 1477525657
Provider Name (Legal Business Name): MICHAEL HENRY VERDOLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 ALVARADO RD SUITE 101
LA MESA CA
91942-8901
US

IV. Provider business mailing address

7051 ALVARADO RD SUITE 101
LA MESA CA
91942-8901
US

V. Phone/Fax

Practice location:
  • Phone: 619-625-1144
  • Fax: 619-872-0964
Mailing address:
  • Phone: 619-625-1144
  • Fax: 619-872-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA92149
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA92149
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA92149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: