Provider Demographics
NPI:1275571010
Name:LAO, JESUS HERRERA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:HERRERA
Last Name:LAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6699 ALVARADO RD STE 2304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5241
Mailing Address - Country:US
Mailing Address - Phone:619-255-8800
Mailing Address - Fax:619-255-8083
Practice Address - Street 1:6699 ALVARADO RD STE 2304
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5241
Practice Address - Country:US
Practice Address - Phone:619-255-8800
Practice Address - Fax:619-255-8083
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72729174400000X, 2081P2900X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No174400000XOther Service ProvidersSpecialist
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine