Provider Demographics
NPI:1598076200
Name:HARBOR SPINE SPECIALTY
Entity Type:Organization
Organization Name:HARBOR SPINE SPECIALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:HOPKINS
Authorized Official - Last Name:LANMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-385-7766
Mailing Address - Street 1:1360 W 6TH ST
Mailing Address - Street 2:EAST BUILDING, UNIT J
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3514
Mailing Address - Country:US
Mailing Address - Phone:310-385-7766
Mailing Address - Fax:310-385-9007
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:EAST BUILDING, UNIT J
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-385-7766
Practice Address - Fax:310-385-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40938174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE29483Medicare UPIN