Healthcare Provider Details

I. General information

NPI: 1255262630
Provider Name (Legal Business Name): OCEAN SPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 E BASELINE RD STE 105
GILBERT AZ
85233-1533
US

IV. Provider business mailing address

1757 E BASELINE RD STE 105
GILBERT AZ
85233-1533
US

V. Phone/Fax

Practice location:
  • Phone: 310-403-5778
  • Fax: 424-326-8667
Mailing address:
  • Phone: 310-403-5778
  • Fax: 424-326-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PRANAY BHOLABHAI PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 217-317-9404