Healthcare Provider Details

I. General information

NPI: 1861539280
Provider Name (Legal Business Name): CONSERVATIVE CARE SPECIALISTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE SUITE 105
VAN NUYS CA
91405
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-6684
  • Fax: 818-781-4457
Mailing address:
  • Phone: 818-550-0900
  • Fax: 303-953-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG056728
License Number StateCA

VIII. Authorized Official

Name: DR. JAYSON A. HYMES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-781-6684