MEDICARE: SPALDING MULTI-SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	61426	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician
3	208VP0000X	Pain Medicine Physician
4	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1104355106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPALDING MULTI-SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	120 S SPALDING DR STE 305
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1800
Country	:	US
Telephone Number	:	310-997-1296
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S SPALDING DR STE 315
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1836
Country	:	US
Telephone Number	:	310-997-1296
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FARDAD MOBIN
Credential	:	MD
Telephone Number	:	310-997-1796

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	07/21/2022

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