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General NPI Number Information
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NPI Number | 1932079084
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA INJURY TREATMENT CENTER MGT
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 15857 POMONA RINCON RD
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City | CHINO HILLS
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State | CA
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Zip | 91709-5505
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Country | US
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Telephone | 844-787-3286
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Fax |
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Provider Business Mailing Address
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Address Line | 15857 POMONA RINCON RD
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City | CHINO HILLS
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State | CA
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Zip | 91709-5505
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Country | US
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Telephone | 844-787-3286
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. ANDRE RIVEROY
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Credential |
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Telephone | 909-261-1263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine 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 | 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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Taxonomy #3
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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