Provider Demographics
NPI:1639184344
Name:INTEGRATED PAIN SPECIALISTS OF SOUTHERN CALIFORNIA, INC.
Entity Type:Organization
Organization Name:INTEGRATED PAIN SPECIALISTS OF SOUTHERN CALIFORNIA, INC.
Other - Org Name:KEVIN S. SMITH, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-398-2988
Mailing Address - Street 1:7525 LINDA VISTA RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5344
Mailing Address - Country:US
Mailing Address - Phone:619-398-2988
Mailing Address - Fax:619-398-2987
Practice Address - Street 1:7525 LINDA VISTA RD STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5344
Practice Address - Country:US
Practice Address - Phone:619-398-2988
Practice Address - Fax:619-398-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70647OtherPHYSICIAN MEDICAL LICENSE