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NPI Code Detail

MEDICARE: MDRS SPINE & SPORT, INC

MEDICARE: MDRS SPINE & SPORT, INC
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
1225X00000XOccupational Therapist
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1952394603
Entity Type Code : Organization
Provider Name (Legal Business Name) : MDRS SPINE & SPORT, INC
Provider Business Mailing Address
First Line : PO BOX 515746
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-5120
Country : US
Telephone Number : 888-208-8526
Fax Number : 858-751-0901
Provider Business Practice Location Address
First Line : 3707 CONVOY ST STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-3754
Country : US
Telephone Number : 858-573-9368
Fax Number : 858-874-0582
Authorized Official
Title or Position : CREDENTIALING OFFICER
Name : ANGEL COLLADO
Credential :
Telephone Number : 858-264-1417
Provider Enumeration Date : 08/29/2005
Last Update Date : 08/29/2024

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Directions to “MDRS SPINE & SPORT, INC ” Practice Location

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