Provider Demographics
NPI:1477003085
Name:SOUTHERN CALIFORNIA SPINE & JOINT INSTITUTE, PC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SPINE & JOINT INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KELLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-375-7972
Mailing Address - Street 1:38860 SKY CANYON DR
Mailing Address - Street 2:BUILDING A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2540
Mailing Address - Country:US
Mailing Address - Phone:951-375-7972
Mailing Address - Fax:877-657-8718
Practice Address - Street 1:38860 SKY CANYON DR
Practice Address - Street 2:BUILDING A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2540
Practice Address - Country:US
Practice Address - Phone:951-375-7972
Practice Address - Fax:877-657-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty