Provider Demographics
NPI:1326188178
Name:SAN DIEGO PAIN MEDICINE
Entity Type:Organization
Organization Name:SAN DIEGO PAIN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-453-7128
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-453-7128
Mailing Address - Fax:
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-453-7128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19503Medicare ID - Type Unspecified