Provider Demographics
NPI:1093094708
Name:TEMECULA VALLEY SPINE & NEUROSURGERY
Entity Type:Organization
Organization Name:TEMECULA VALLEY SPINE & NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-973-7294
Mailing Address - Street 1:25470 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4900
Mailing Address - Country:US
Mailing Address - Phone:951-973-7294
Mailing Address - Fax:951-973-7289
Practice Address - Street 1:27720 JEFFERSON AVE
Practice Address - Street 2:SUITE 100B
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2610
Practice Address - Country:US
Practice Address - Phone:951-587-3739
Practice Address - Fax:951-693-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71689207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty