=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740174655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J&P SPINE CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7050 N RECREATION AVE STE 101
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-538-3145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6079 N FRESNO ST STE 101
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710-5276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-294-2657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING
-----------------------------------------------------
Name | GINGER JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-294-2657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------