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Agereversalmd.com A Professional Corporation
Pain Clinic/Center in La Jolla, California
NPI 1194450023

Agereversalmd.com A Professional Corporation is a Pain Clinic/Center based in Encinitas, CA and is specialized in Pain. Agereversalmd.com A Professional Corporation practices in La Jolla, CA. The NPI Number for Agereversalmd.com A Professional Corporation is 1194450023 and holds a License No. (California).

The current practice location address for Agereversalmd.com A Professional Corporation is 3252 Holiday Ct Ste 211, La Jolla, CA and can be reached out via phone at 858-776-0544 and via fax at 760-692-4411.

Location: 3252 Holiday Ct Ste 211, La Jolla, CA, 92024-1317
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1194450023
Provider Name
Agereversalmd.com A Professional Corporation
Credential
Provider Entity Type
Organization
Address
3252 Holiday Ct Ste 211, La Jolla, CA, 92024-1317
Phone Number
858-776-0544
Fax Number
760-692-4411
Provider Enumeration Date
07/24/2022
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1285737569 01 CA INDIVIDUAL NPI
institution
Provider Business Practice Location Address Details
Address
3252 Holiday Ct Ste 211
City
La Jolla
State
California
Zip
92037-0027
Phone Number
858-776-0544
Fax Number
760-692-4411
person
Provider Business Mailing Address Details
Address
3252 Holiday Ct Ste 211
City
La Jolla
State
California
Zip
92037-0027
Phone Number
858-776-0544
Fax Number
760-692-4411
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Obstetrics & Gynecology
Speciality
Gynecology
Taxonomy
207VG0400X
License No.
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Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Agencies
Classification
Public Health or Welfare
Speciality
-
Taxonomy
251K00000X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
261QP2300X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Pain
Taxonomy
261QP3300X
License No.
()
Definition
Definition to come...
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