Provider Demographics
NPI:1073833398
Name:S PINE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:S PINE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:PINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-757-2235
Mailing Address - Street 1:9601 KENTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2671
Mailing Address - Country:US
Mailing Address - Phone:818-757-2235
Mailing Address - Fax:
Practice Address - Street 1:637 LUCAS AVE STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1912
Practice Address - Country:US
Practice Address - Phone:818-757-2235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33483207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356352108Medicaid