Provider Demographics
NPI:1457462731
Name:PINNACLE BRAIN AND SPINE CENTER
Entity Type:Organization
Organization Name:PINNACLE BRAIN AND SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:RONDEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-633-5155
Mailing Address - Street 1:6701 AIRPORT BLVD STE D146
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6701
Mailing Address - Country:US
Mailing Address - Phone:251-633-5155
Mailing Address - Fax:251-633-5125
Practice Address - Street 1:6701 AIRPORT BLVD STE D146
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6701
Practice Address - Country:US
Practice Address - Phone:251-633-5155
Practice Address - Fax:251-633-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012906207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529923400Medicaid
ALDD3322OtherMEDICARE RAILROAD
5906690001Medicare NSC