Healthcare Provider Details

I. General information

NPI: 1407650625
Provider Name (Legal Business Name): ORTHOPEDIC SPINE AND URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE STE 380
LOS ANGELES CA
90015-3070
US

IV. Provider business mailing address

17525 VENTURA BLVD STE 210
ENCINO CA
91316-5111
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-2589
  • Fax: 833-450-5061
Mailing address:
  • Phone: 818-986-2861
  • Fax: 818-638-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN ATTENELLO
Title or Position: OWNER
Credential: MD
Phone: 310-337-2589