Healthcare Provider Details

I. General information

NPI: 1831599802
Provider Name (Legal Business Name): SPINE GROUP BEVERLY HILLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 WILSHIRE BLVD STE 930
SANTA MONICA CA
90403-4803
US

IV. Provider business mailing address

2811 WILSHIRE BLVD STE 930
SANTA MONICA CA
90403-4803
US

V. Phone/Fax

Practice location:
  • Phone: 310-881-3730
  • Fax: 310-496-1386
Mailing address:
  • Phone: 310-881-3730
  • Fax: 310-496-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN J REGAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-881-3730