Healthcare Provider Details

I. General information

NPI: 1093697641
Provider Name (Legal Business Name): J&P SPINE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6079 N FRESNO ST STE 101
FRESNO CA
93710-5276
US

IV. Provider business mailing address

6079 N FRESNO ST STE 101
FRESNO CA
93710-5276
US

V. Phone/Fax

Practice location:
  • Phone: 559-538-3145
  • Fax: 661-310-3848
Mailing address:
  • Phone: 559-538-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTICE OTCHERE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 682-433-9287