Healthcare Provider Details

I. General information

NPI: 1972884013
Provider Name (Legal Business Name): SMART SPINE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E. HUNTINGTON DRIVE
ARCADIA CA
91006
US

IV. Provider business mailing address

131 E. HUNTINGTON DRIVE
ARCADIA CA
91006
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-0326
  • Fax: 626-446-5155
Mailing address:
  • Phone: 626-445-0326
  • Fax: 626-445-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number220607
License Number StateCA

VIII. Authorized Official

Name: MARIA I LANDEROS
Title or Position: ASSISTANT/BILLER
Credential:
Phone: 626-445-0326