Provider Demographics
NPI:1851530711
Name:SPINE INSTITUTE OF SAN DIEGO, INC
Entity Type:Organization
Organization Name:SPINE INSTITUTE OF SAN DIEGO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAISZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-265-7912
Mailing Address - Street 1:6719 ALVARADO RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5270
Mailing Address - Country:US
Mailing Address - Phone:619-229-5340
Mailing Address - Fax:619-229-7922
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:SUITE 308
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5270
Practice Address - Country:US
Practice Address - Phone:619-229-5340
Practice Address - Fax:619-229-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty