Basic Information
| Provider Information | |||||||||
| NPI: | 1427557230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA JOINT & SPINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8135 SARATOGA WAY | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957624590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162358775 | ||||||||
| FaxNumber: | 9166936117 | ||||||||
| Practice Location | |||||||||
| Address1: | 8135 SARATOGA WAY | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727633893 | ||||||||
| FaxNumber: | 9726926745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2018 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | BOON | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER / AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4805670269 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.