Provider Demographics
NPI:1265124176
Name:SOCAL SCOLIOSIS CARE
Entity type:Organization
Organization Name:SOCAL SCOLIOSIS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:818-428-5218
Mailing Address - Street 1:9557 HARVEST VISTA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5732
Mailing Address - Country:US
Mailing Address - Phone:650-714-3877
Mailing Address - Fax:
Practice Address - Street 1:16430 VENTURA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2135
Practice Address - Country:US
Practice Address - Phone:818-428-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies