Provider Demographics
NPI:1306603089
Name:RECOVER MEDICAL GROUP PC
Entity type:Organization
Organization Name:RECOVER MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CHRISTENSEN-GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-913-0781
Mailing Address - Street 1:120 BIRMINGHAM DR STE 240A
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1757
Mailing Address - Country:US
Mailing Address - Phone:858-208-0121
Mailing Address - Fax:
Practice Address - Street 1:8150 SIERRA COLLEGE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-9417
Practice Address - Country:US
Practice Address - Phone:858-208-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVER MEDICAL GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty