Healthcare Provider Details

I. General information

NPI: 1053483206
Provider Name (Legal Business Name): SPINE NETWORK OF CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 BUSH ST STE 300A
SAN FRANCISCO CA
94109-5974
US

IV. Provider business mailing address

PO BOX 640747
SAN FRANCISCO CA
94164-0747
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-4575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberFNP22369
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNFP22369
License Number StateCA

VIII. Authorized Official

Name: TRUDY MAURER
Title or Position: CEO
Credential:
Phone: 415-673-4575