Healthcare Provider Details

I. General information

NPI: 1427557230
Provider Name (Legal Business Name): CALIFORNIA JOINT & SPINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 SARATOGA WAY
EL DORADO HILLS CA
95762
US

IV. Provider business mailing address

8135 SARATOGA WAY
EL DORADO HILLS CA
95762-4590
US

V. Phone/Fax

Practice location:
  • Phone: 972-763-3893
  • Fax: 972-692-6745
Mailing address:
  • Phone: 916-235-8775
  • Fax: 916-693-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER / AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269