Provider Demographics
NPI:1457647117
Name:VERDOLIN PAIN SPECIALISTS, INC.
Entity Type:Organization
Organization Name:VERDOLIN PAIN SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:VERDOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-213-6665
Mailing Address - Street 1:891 KUHN DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3551
Mailing Address - Country:US
Mailing Address - Phone:619-761-5308
Mailing Address - Fax:619-752-3968
Practice Address - Street 1:891 KUHN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3551
Practice Address - Country:US
Practice Address - Phone:619-761-5308
Practice Address - Fax:619-752-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92149207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92149Medicare UPIN
CA14373449578 PENDINGMedicare PIN
CAW21019 PENDINGMedicare PIN