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General NPI Number Information
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NPI Number | 1760159198
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Entity Type | Organization
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Legal Business Name | EVERGREEN SPINE AND PAIN CENTERS
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 3762 TIBBETTS ST
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City | RIVERSIDE
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State | CA
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Zip | 92506-2605
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Country | US
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Telephone | 949-414-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 3762 TIBBETTS ST
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City | RIVERSIDE
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State | CA
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Zip | 92506-2605
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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 | CEO
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Name | DR. YI CAI ISAAC TONG
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Credential | MD
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Telephone | 917-745-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology 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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) 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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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