Provider Demographics
NPI:1174097612
Name:SOUTHERN CALIFORNIA REGENERATIVE MEDICAL INC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA REGENERATIVE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MINU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-722-3202
Mailing Address - Street 1:2111 S EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-9000
Mailing Address - Country:US
Mailing Address - Phone:760-722-3202
Mailing Address - Fax:760-979-0018
Practice Address - Street 1:2111 S EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-9000
Practice Address - Country:US
Practice Address - Phone:760-722-3202
Practice Address - Fax:760-979-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty