| Pain Center - San Diego Pc | |
|
4033 3rd Ave Ste 430 San Diego CA 92103-2117 | |
| (619) 578-3740 | |
| (858) 437-6702 |
| Full Name | Pain Center - San Diego Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4033 3rd Ave Ste 430, San Diego, California |
| Authorized Official Name and Position | Sandra A Thompson (OWNER) |
| Authorized Official Contact | 6195783740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pain Center - San Diego Pc 4033 3rd Ave Ste 200 San Diego CA 92103-2198 Ph: (619) 578-3740 | Pain Center - San Diego Pc 4033 3rd Ave Ste 430 San Diego CA 92103-2117 Ph: (619) 578-3740 |
| NPI Number | 1538710611 |
|---|---|
| Provider Enumeration Date | 09/20/2019 |
| Last Update Date | 08/01/2024 |
| Medicare PECOS PAC ID | 1052749108 |
|---|---|
| Medicare Enrollment ID | O20200324000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538710611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lovella Tan Medilo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659930485 PECOS PAC ID: 5597096628 Enrollment ID: I20191003003056 |
| Provider Name | Sandra A Thompson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1326085713 PECOS PAC ID: 3173436680 Enrollment ID: I20200324000884 |
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