Provider Demographics
NPI:1861832735
Name:DOUGLAS DOBECKI, MEDICAL DOCTOR, INCORPORATED
Entity Type:Organization
Organization Name:DOUGLAS DOBECKI, MEDICAL DOCTOR, INCORPORATED
Other - Org Name:SAN DIEGO PAIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DOBECKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:858-576-1011
Mailing Address - Street 1:7625 MESA COLLEGE DR
Mailing Address - Street 2:SUITE 315A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5343
Mailing Address - Country:US
Mailing Address - Phone:858-576-1011
Mailing Address - Fax:858-576-1025
Practice Address - Street 1:7625 MESA COLLEGE DR
Practice Address - Street 2:SUITE 315A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:858-576-1011
Practice Address - Fax:858-576-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81761207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA81761Medicare PIN
CAI41315Medicare UPIN