Provider Demographics
NPI:1477096170
Name:LA JOLLA ORTHOPEDICS & PAIN MANAGEMENT CENTER, INC.
Entity Type:Organization
Organization Name:LA JOLLA ORTHOPEDICS & PAIN MANAGEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:QIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-571-3630
Mailing Address - Street 1:276 CHURCH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3703 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4033
Practice Address - Country:US
Practice Address - Phone:858-571-3630
Practice Address - Fax:858-541-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty