Provider Demographics
NPI:1053655191
Name:ORTHOSPINE ADVANCE HEALTH, INC
Entity Type:Organization
Organization Name:ORTHOSPINE ADVANCE HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-349-8429
Mailing Address - Street 1:3180 COLLINS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3161
Mailing Address - Country:US
Mailing Address - Phone:209-349-8429
Mailing Address - Fax:209-720-0193
Practice Address - Street 1:3180 COLLINS DR
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3161
Practice Address - Country:US
Practice Address - Phone:209-349-8429
Practice Address - Fax:209-720-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115417207X00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty