Provider Demographics
NPI:1104208685
Name:RENO SPINE CENTER
Entity Type:Organization
Organization Name:RENO SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARDAVAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASLIE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:775-322-1230
Mailing Address - Street 1:1475 TERMINAL WAY
Mailing Address - Street 2:STE C1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3430
Mailing Address - Country:US
Mailing Address - Phone:775-322-1230
Mailing Address - Fax:775-322-1238
Practice Address - Street 1:1475 TERMINAL WAY
Practice Address - Street 2:STE C1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3430
Practice Address - Country:US
Practice Address - Phone:775-322-1230
Practice Address - Fax:775-322-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherSTATE LICENSE NUMBER