Provider Demographics
NPI:1144520586
Name:SORRENTO VALLEY PAIN RELIEF CENTER
Entity type:Organization
Organization Name:SORRENTO VALLEY PAIN RELIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMEET
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-404-5944
Mailing Address - Street 1:5955 MIRA MESA BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4304
Mailing Address - Country:US
Mailing Address - Phone:858-404-5944
Mailing Address - Fax:858-404-5934
Practice Address - Street 1:5955 MIRA MESA BLVD
Practice Address - Street 2:STE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4304
Practice Address - Country:US
Practice Address - Phone:858-404-5944
Practice Address - Fax:858-404-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112159207L00000X
2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty