Healthcare Provider Details

I. General information

NPI: 1134083116
Provider Name (Legal Business Name): PRECISION SPINE & MOTION IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7595 REDWOOD BLVD STE 104
NOVATO CA
94945-7705
US

IV. Provider business mailing address

7595 REDWOOD BLVD STE 104
NOVATO CA
94945-7705
US

V. Phone/Fax

Practice location:
  • Phone: 415-432-9285
  • Fax:
Mailing address:
  • Phone: 415-432-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLINA CARBUNGCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 415-432-9285