Provider Demographics
NPI:1578883674
Name:DOVE NEUROPSYCHIATRIC AND PAIN
Entity Type:Organization
Organization Name:DOVE NEUROPSYCHIATRIC AND PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-810-0382
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-1927
Mailing Address - Country:US
Mailing Address - Phone:858-810-0382
Mailing Address - Fax:858-633-0382
Practice Address - Street 1:3939 RUFFIN ROAD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-810-0382
Practice Address - Fax:858-633-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA556672084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GF85083Medicare UPIN
9031036Medicare PIN
CADP170ZMedicare PIN
CADO652AMedicare PIN