Healthcare Provider Details

I. General information

NPI: 1699922518
Provider Name (Legal Business Name): CONSERVATIVE CARE SPECIALIST MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD SUITE 204
LOS ANGELES CA
90036
US

IV. Provider business mailing address

6815 NOBLE AVE SUITE 105
VAN NUYS CA
91405-3796
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-2300
  • Fax: 323-938-2330
Mailing address:
  • Phone: 818-781-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG56728
License Number StateCA

VIII. Authorized Official

Name: DR. JAYSON HYMES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-938-2300