Provider Demographics
NPI:1609916923
Name:SPINE CARE & ORTHOPEDIC PHYSICIANS
Entity Type:Organization
Organization Name:SPINE CARE & ORTHOPEDIC PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-337-3700
Mailing Address - Street 1:8610 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE #109
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4008
Mailing Address - Country:US
Mailing Address - Phone:310-337-3700
Mailing Address - Fax:310-337-0947
Practice Address - Street 1:8610 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE #109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4008
Practice Address - Country:US
Practice Address - Phone:310-337-3700
Practice Address - Fax:310-337-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31730207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty