Healthcare Provider Details

I. General information

NPI: 1578692653
Provider Name (Legal Business Name): PERRI AND SIDDIQUE SPINE SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD SUITE #800
LOS ANGELES CA
90048-4165
US

IV. Provider business mailing address

125 EUCALYPTUS DR
EL SEGUNDO CA
90245-3839
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PERRI
Title or Position: CO-OWNER
Credential: M.D.
Phone: 310-423-9900