Provider Demographics
NPI:1235517442
Name:SOUTHERN CALIFORNIA BRAIN & SPINE SURGERY
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA BRAIN & SPINE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOKSHA
Authorized Official - Middle Name:GANDHARI
Authorized Official - Last Name:RANASINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-369-4583
Mailing Address - Street 1:101 E BEVERLY BLVD STE 404A
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4317
Mailing Address - Country:US
Mailing Address - Phone:213-369-4583
Mailing Address - Fax:866-876-7956
Practice Address - Street 1:101 E BEVERLY BLVD STE 404A
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:213-369-4583
Practice Address - Fax:866-876-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB235126OtherMEDICARE PTAN