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General NPI Number Information
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NPI Number | 1518620988
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Entity Type | Organization
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Legal Business Name | SPINE JOINT CARE INC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 1058 MURRIETA BLVD
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City | LIVERMORE
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State | CA
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Zip | 94550-4111
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Country | US
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Telephone | 925-272-9022
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Fax |
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Provider Business Mailing Address
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Address Line | 2629 MEADOWBROOK DR
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City | SANTA CLARA
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State | CA
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Zip | 95051-1113
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Country | US
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Telephone | 408-636-6488
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. FAJIE MA
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Credential | MD
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Telephone | 408-636-6488
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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 |
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License Number State |
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