Healthcare Provider Details

I. General information

NPI: 1477096170
Provider Name (Legal Business Name): LA JOLLA ORTHOPEDICS & PAIN MANAGEMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 CAMINO DEL RIO S SUITE 200
SAN DIEGO CA
92108-4033
US

IV. Provider business mailing address

276 CHURCH AVE SUITE B
CHULA VISTA CA
91910-2729
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-3630
  • Fax: 858-541-4440
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN QIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 858-571-3630