MEDICARE: CENTERS OF REHABILITATION & PAIN MEDICINE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A86192	CA

General Provider Information

NPI Number	:	1184933830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERS OF REHABILITATION & PAIN MEDICINE INC

Provider Business Mailing Address
First Line	:	840 E MCKELLIPS RD STE 105
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-9654
Country	:	US
Telephone Number	:	602-491-0701
Fax Number	:	480-631-0581

Provider Business Practice Location Address
First Line	:	1041 E YORBA LINDA BLVD STE 210
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3763
Country	:	US
Telephone Number	:	714-223-7000
Fax Number	:	833-471-2059

Authorized Official
Title or Position	:	PRESIDENT/CMO
Name	:	SHANE SPEIRS
Credential	:	MD
Telephone Number	:	480-495-5485

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	10/09/2023

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