Healthcare Provider Details

I. General information

NPI: 1053655191
Provider Name (Legal Business Name): ORTHOSPINE ADVANCE HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E YOSEMITE AVE STE 101
MERCED CA
95340-9165
US

IV. Provider business mailing address

330 E YOSEMITE AVE STE 101
MERCED CA
95340-9165
US

V. Phone/Fax

Practice location:
  • Phone: 209-349-8429
  • Fax: 209-720-0193
Mailing address:
  • Phone: 209-349-8429
  • Fax: 209-720-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA115417
License Number StateCA

VIII. Authorized Official

Name: DR. GABRIEL GARCIA-DIAZ
Title or Position: OWNER
Credential: M.D.
Phone: 209-349-8429