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General NPI Number Information
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NPI Number | 1437349578
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Entity Type | Organization
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Legal Business Name | PAIN CONTROL ASSOCIATES OF SAN DIEGO, INC.
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 2452 FENTON ST SUITE 101
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City | CHULA VISTA
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State | CA
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Zip | 91914-4551
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Country | US
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Telephone | 619-271-1683
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Fax | 619-651-7033
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Provider Business Mailing Address
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Address Line | 2452 FENTON ST SUITE 101
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City | CHULA VISTA
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State | CA
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Zip | 91914-3599
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Country | US
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Telephone | 619-271-1683
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Fax | 619-651-7033
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL H VERDOLIN
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Credential | MD
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Telephone | 619-271-1683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A 92149
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License Number State | CA
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