Healthcare Provider Details

I. General information

NPI: 1578883674
Provider Name (Legal Business Name): DOVE NEUROPSYCHIATRIC AND PAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 RUFFIN ROAD
SAN DIEGO CA
92123
US

IV. Provider business mailing address

PO BOX 1927
LA JOLLA CA
92038-1927
US

V. Phone/Fax

Practice location:
  • Phone: 858-810-0382
  • Fax: 858-633-0382
Mailing address:
  • Phone: 858-810-0382
  • Fax: 858-633-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA55667
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA55667
License Number StateCA

VIII. Authorized Official

Name: KRISTI ANN DOVE
Title or Position: M.D./PRESIDENT
Credential: M.D.
Phone: 858-810-0382