Healthcare Provider Details

I. General information

NPI: 1114473972
Provider Name (Legal Business Name): BURBANK SPINE AND PAIN SURGERY CENTER A PROFESSIONAL MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 W MAGNOLIA BLVD SUITE 270
BURBANK CA
91506-1753
US

IV. Provider business mailing address

2211 W MAGNOLIA BLVD STE 270
BURBANK CA
91506-1756
US

V. Phone/Fax

Practice location:
  • Phone: 818-325-2088
  • Fax: 818-563-6201
Mailing address:
  • Phone: 818-325-2088
  • Fax: 818-563-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: KARRIE SIMONIAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 818-588-4150