Healthcare Provider Details

I. General information

NPI: 1952673725
Provider Name (Legal Business Name): CALIFORNIA ORTHOPAEDIC & SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 WILSHIRE BLVD STE 935
SANTA MONICA CA
90403-5400
US

IV. Provider business mailing address

1223 WILSHIRE BLVD STE 935
SANTA MONICA CA
90403-5400
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-7278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG73590
License Number StateCA

VIII. Authorized Official

Name: SCOTT RADIN
Title or Position: OFFICER
Credential:
Phone: 562-490-7278