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General NPI Number Information
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NPI Number | 1184933830
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Entity Type | Organization
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Legal Business Name | CENTERS OF REHABILITATION & PAIN MEDICINE INC
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1041 E YORBA LINDA BLVD STE 210
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City | PLACENTIA
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State | CA
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Zip | 92870-3763
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Country | US
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Telephone | 714-223-7000
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Fax | 833-471-2059
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Provider Business Mailing Address
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Address Line | 840 E MCKELLIPS RD STE 105
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City | MESA
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State | AZ
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Zip | 85203-9654
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Country | US
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Telephone | 602-491-0701
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Fax | 480-631-0581
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Authorized Official
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Title or Position | PRESIDENT/CMO
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Name | SHANE SPEIRS
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Credential | MD
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Telephone | 480-495-5485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A86192
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License Number State | CA
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