Provider Demographics
NPI:1477525657
Name:VERDOLIN, MICHAEL HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HENRY
Last Name:VERDOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7051 ALVARADO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-8901
Mailing Address - Country:US
Mailing Address - Phone:619-625-1144
Mailing Address - Fax:619-872-0964
Practice Address - Street 1:7051 ALVARADO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-8901
Practice Address - Country:US
Practice Address - Phone:619-625-1144
Practice Address - Fax:619-872-0964
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92149207LP2900X, 207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21019Medicare PIN