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General NPI Number Information
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NPI Number | 1205342417
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Entity Type | Organization
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Legal Business Name | CENTER OF REGENERATIVE MEDICINE PHYSICIAN ASSISTANT SERVICES INC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 18710 AMAR RD STE A
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City | WALNUT
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State | CA
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Zip | 91789-4571
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Country | US
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Telephone | 626-522-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 18710 AMAR RD STE A
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City | WALNUT
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State | CA
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Zip | 91789-4571
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Country | US
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Telephone | 626-522-6553
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Fax | 844-400-1763
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG L CHASE
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Credential | PA-C, DC
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Telephone | 626-522-6553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 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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