Provider Demographics
NPI:1225267388
Name:SPECTRUM MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SPECTRUM MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-293-4571
Mailing Address - Street 1:149 S. BARRINGTON
Mailing Address - Street 2:#754
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:714-293-4571
Mailing Address - Fax:310-471-9521
Practice Address - Street 1:5211 E WASHINGTON BLVD
Practice Address - Street 2:SUTIE 18
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-3959
Practice Address - Country:US
Practice Address - Phone:714-293-4571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty