Provider Demographics
NPI:1851507792
Name:SAN DIEGO NEUROSURGERY AND SPINE INSTITUTE
Entity Type:Organization
Organization Name:SAN DIEGO NEUROSURGERY AND SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-634-5900
Mailing Address - Street 1:561 SAXONY PL STE 102
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7700
Mailing Address - Country:US
Mailing Address - Phone:760-634-5900
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR STE 501C
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3058
Practice Address - Country:US
Practice Address - Phone:760-634-5900
Practice Address - Fax:760-634-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091330Medicaid
CAW15450Medicare ID - Type Unspecified