Healthcare Provider Details

I. General information

NPI: 1821426305
Provider Name (Legal Business Name): AMERICAN SPINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 FULLERTON AVE SUITE #104
CORONA CA
92881-3103
US

IV. Provider business mailing address

PO BOX 3098
TORRANCE CA
90510-3098
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-0100
  • Fax: 951-734-7245
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA90421
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA90421
License Number StateCA

VIII. Authorized Official

Name: KHURAM AKBAR SIAL
Title or Position: PRESIDENT/ OWNER
Credential: MD
Phone: 310-792-3914