Provider Demographics
NPI:1972884013
Name:SMART SPINE INSTITUTE INC
Entity Type:Organization
Organization Name:SMART SPINE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:LANDEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-445-0326
Mailing Address - Street 1:131 E. HUNTINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-445-0326
Mailing Address - Fax:626-445-5155
Practice Address - Street 1:131 E. HUNTINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-445-0326
Practice Address - Fax:626-446-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220607207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty