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General NPI Number Information
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NPI Number | 1225330830
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Entity Type | Organization
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Legal Business Name | SPINE AND PAIN CARE MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 250 EL CAMINO REAL SUITE 104
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City | TUSTIN
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State | CA
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Zip | 92780-3655
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Country | US
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Telephone | 714-508-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 250 EL CAMINO REAL SUITE 104
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City | TUSTIN
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State | CA
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Zip | 92780-3655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY OLSEN
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Credential | MD
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Telephone | 714-508-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | G69571
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License Number State | CA
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