Healthcare Provider Details

I. General information

NPI: 1497323570
Provider Name (Legal Business Name): REGENERATIVE SPINE, PAIN, AND NEUROPATHY CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 Q ST STE 105
BAKERSFIELD CA
93301-1645
US

IV. Provider business mailing address

206 E OCEAN AVE
LOMPOC CA
93436-6825
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-7361
  • Fax:
Mailing address:
  • Phone: 847-912-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LINSNER
Title or Position: IN-HOUSE COUNSEL
Credential:
Phone: 847-912-2297