Provider Demographics
NPI:1831599802
Name:SPINE GROUP BEVERLY HILLS INC
Entity type:Organization
Organization Name:SPINE GROUP BEVERLY HILLS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-881-3730
Mailing Address - Street 1:2811 WILSHIRE BLVD STE 930
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-881-3730
Mailing Address - Fax:310-496-1386
Practice Address - Street 1:2811 WILSHIRE BLVD STE 930
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-881-3730
Practice Address - Fax:310-496-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty