Healthcare Provider Details

I. General information

NPI: 1720280738
Provider Name (Legal Business Name): SAN DIEGO SPINE CENTER, AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 CONVOY ST 114
SAN DIEGO CA
92111-3742
US

IV. Provider business mailing address

3760 CONVOY ST 114
SAN DIEGO CA
92111-3742
US

V. Phone/Fax

Practice location:
  • Phone: 858-715-8444
  • Fax: 858-715-8324
Mailing address:
  • Phone: 858-715-8444
  • Fax: 858-715-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG84012
License Number StateCA

VIII. Authorized Official

Name: DR. ERIC STEVEN KORSH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-715-8444