Healthcare Provider Details

I. General information

NPI: 1528928421
Provider Name (Legal Business Name): SPINE & NERVE DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 SUN CITY LN STE 111
LINCOLN CA
95648-7519
US

IV. Provider business mailing address

4200 DOUGLAS BLVD
GRANITE BAY CA
95746-5902
US

V. Phone/Fax

Practice location:
  • Phone: 916-772-5325
  • Fax:
Mailing address:
  • Phone: 916-772-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VINAY MOOLA REDDY
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 916-772-5325