Basic Information
| Provider Information | |||||||||
| NPI: | 1205195732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPANISH HILLS INTERVENTIONAL PAIN SPECIALISTS INC A MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 PASEO CAMARILLO | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930106073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055855201 | ||||||||
| FaxNumber: | 8055978354 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 PASEO CAMARILLO | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930106073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054848558 | ||||||||
| FaxNumber: | 8054843099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2012 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8054848558 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.