Provider Demographics
NPI:1467679977
Name:WOLBERS AND POREE MEDICAL CORP
Entity Type:Organization
Organization Name:WOLBERS AND POREE MEDICAL CORP
Other - Org Name:PAIN CLINIC OF MONTEREY BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-684-0600
Mailing Address - Street 1:9057C SOQUEL DR
Mailing Address - Street 2:SUITE # A
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4052
Mailing Address - Country:US
Mailing Address - Phone:831-684-0600
Mailing Address - Fax:831-684-0606
Practice Address - Street 1:9057C SOQUEL DR
Practice Address - Street 2:SUITE # A
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4052
Practice Address - Country:US
Practice Address - Phone:831-684-0600
Practice Address - Fax:831-684-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80646208VP0000X
CAA66092208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22870ZMedicare UPIN