Healthcare Provider Details

I. General information

NPI: 1114330461
Provider Name (Legal Business Name): CALIFORNIA SPINE AND NEUROSURGERY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 S BASCOM AVE SUITE I
SAN JOSE CA
95008-7300
US

IV. Provider business mailing address

3425 S BASCOM AVE SUITE I
CAMPBELL CA
95008-7300
US

V. Phone/Fax

Practice location:
  • Phone: 408-377-3331
  • Fax: 408-377-3332
Mailing address:
  • Phone: 408-377-3331
  • Fax: 408-377-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA83263
License Number StateCA

VIII. Authorized Official

Name: DR. ADEBUKOLA A. ONIBOKUN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-377-3331