Provider Demographics
NPI:1881688554
Name:SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA INC
Entity Type:Organization
Organization Name:SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA MARIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAGATTUTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-928-1115
Mailing Address - Street 1:PO BOX 1699
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-1699
Mailing Address - Country:US
Mailing Address - Phone:805-928-1115
Mailing Address - Fax:805-928-1276
Practice Address - Street 1:135 CARMEN LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7729
Practice Address - Country:US
Practice Address - Phone:805-928-1115
Practice Address - Fax:805-928-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000561261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
184399000OtherUSDL PIN
CA7399463OtherAETNA HEALTH PROVIDER NUMBER
CA050000561OtherDPH SURGICAL CLINIC LICENSE
CAP00305321OtherRAILROAD MEDICARE GROUP PTAN
5544477OtherCCN FIRST HEALTH PIN
CACLN 1070OtherDCA BOARD OF PHARMACY CLINIC PERMIT
CAFNP 32177OtherCA MEDICAL BOARD FICTITIOUS NAME PERMIT
CA21163OtherCITY OF SANTA MARIA BUSINESS LICENSE
CA05-C0001539OtherDHS MEDI-CAL CERTIFICATION NUMBER
WA212471OtherWA STATE DOL
CAC2179691OtherSECRETARY OF STATE CORPORATION
CASUR01539FMedicaid
CASUR01539FMedicaid
WA212471OtherWA STATE DOL
CAC2179691OtherSECRETARY OF STATE CORPORATION
CAS051539Medicare PIN