Healthcare Provider Details

I. General information

NPI: 1306603089
Provider Name (Legal Business Name): RECOVER MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 SIERRA COLLEGE BLVD STE 250
ROSEVILLE CA
95661-9417
US

IV. Provider business mailing address

120 BIRMINGHAM DR STE 240A
CARDIFF CA
92007-1757
US

V. Phone/Fax

Practice location:
  • Phone: 858-208-0121
  • Fax:
Mailing address:
  • Phone: 858-208-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: IAN MATTHEW CHRISTENSEN-GIBBONS
Title or Position: HEAD OF OPERATIONS
Credential:
Phone: 310-913-0781