Healthcare Provider Details

I. General information

NPI: 1205342417
Provider Name (Legal Business Name): CENTER OF REGENERATIVE MEDICINE PHYSICIAN ASSISTANT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 02/02/2024
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18710 AMAR RD STE A
WALNUT CA
91789-4571
US

IV. Provider business mailing address

18710 AMAR RD STE A
WALNUT CA
91789-4571
US

V. Phone/Fax

Practice location:
  • Phone: 626-522-6553
  • Fax:
Mailing address:
  • Phone: 626-522-6553
  • Fax: 844-400-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG L CHASE
Title or Position: PRESIDENT
Credential: PA-C, DC
Phone: 626-522-6553