Healthcare Provider Details

I. General information

NPI: 1245163393
Provider Name (Legal Business Name): CALIFORNIA PAIN & RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PLAZA DR STE 110
FOLSOM CA
95630-4782
US

IV. Provider business mailing address

1024 IRON POINT RD # 17254220
FOLSOM CA
95630-8013
US

V. Phone/Fax

Practice location:
  • Phone: 281-831-6290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIRT REPP
Title or Position: TREASURER
Credential:
Phone: 281-831-6290