Healthcare Provider Details

I. General information

NPI: 1841604972
Provider Name (Legal Business Name): SPECTRUM PAIN MANAGEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14365 PIPELINE AVE
CHINO CA
91710-5642
US

IV. Provider business mailing address

14365 PIPELINE AVE
CHINO CA
91710-5642
US

V. Phone/Fax

Practice location:
  • Phone: 951-699-0303
  • Fax: 951-699-0603
Mailing address:
  • Phone: 951-699-0303
  • Fax: 951-699-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONY CASTILLO
Title or Position: CEO
Credential:
Phone: 951-699-0303