Healthcare Provider Details

I. General information

NPI: 1174063218
Provider Name (Legal Business Name): XCELL SPORTS AND REGENERATIVE MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 PASEO DEL NORTE SUITE 100
CARLSBAD CA
92011-1112
US

IV. Provider business mailing address

6125 PASEO DEL NORTE SUITE 100
CARLSBAD CA
92011-1112
US

V. Phone/Fax

Practice location:
  • Phone: 760-909-2355
  • Fax:
Mailing address:
  • Phone: 760-909-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG84249
License Number StateCA

VIII. Authorized Official

Name: CHRISTOPHER J ROGERS
Title or Position: DIRECTOR
Credential: MD
Phone: 760-909-2355