Healthcare Provider Details

I. General information

NPI: 1558903849
Provider Name (Legal Business Name): CALIFORNIA PAIN SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 07/01/2023
Certification Date: 07/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 GREENBACK LN STE 102
CITRUS HEIGHTS CA
95610-5800
US

IV. Provider business mailing address

7777 GREENBACK LN STE 102
CITRUS HEIGHTS CA
95610-5800
US

V. Phone/Fax

Practice location:
  • Phone: 916-352-7777
  • Fax: 877-354-4771
Mailing address:
  • Phone: 916-352-7777
  • Fax: 877-354-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEFFREY LANE BROOKS
Title or Position: PRESIDENT
Credential: MD
Phone: 707-346-4444