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General NPI Number Information
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NPI Number | 1962890103
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Entity Type | Organization
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Legal Business Name | SPECTRUMCARE REHABILITATION MEDICAL
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 3434 VILLA LN STE 150
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City | NAPA
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State | CA
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Zip | 94558-6449
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Country | US
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Telephone | 707-252-4507
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Fax | 707-258-2780
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Provider Business Mailing Address
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Address Line | 3434 VILLA LN STE 150
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City | NAPA
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State | CA
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Zip | 94558-6449
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Country | US
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Telephone | 707-252-4507
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Fax | 707-258-2780
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MRS. DARLA HARRISON
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Credential | CMM
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Telephone | 707-252-4507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G64848
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License Number State | CA
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