Provider Demographics
NPI:1871188862
Name:BIRCH PAIN & SPINE GROUP
Entity Type:Organization
Organization Name:BIRCH PAIN & SPINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VOICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSOFI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-830-1799
Mailing Address - Street 1:227 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4015
Mailing Address - Country:US
Mailing Address - Phone:209-830-1799
Mailing Address - Fax:209-835-5034
Practice Address - Street 1:227 E 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4015
Practice Address - Country:US
Practice Address - Phone:209-830-1799
Practice Address - Fax:209-835-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty