Healthcare Provider Details

I. General information

NPI: 1205195732
Provider Name (Legal Business Name): SPANISH HILLS INTERVENTIONAL PAIN SPECIALISTS INC A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PASEO CAMARILLO
CAMARILLO CA
93010-6073
US

IV. Provider business mailing address

1100 PASEO CAMARILLO
CAMARILLO CA
93010-6073
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-8558
  • Fax: 805-484-3099
Mailing address:
  • Phone: 805-585-5201
  • Fax: 805-597-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANN COX
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-484-8558