Healthcare Provider Details

I. General information

NPI: 1306762273
Provider Name (Legal Business Name): ST CHARLES SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NEWBURY RD
THOUSAND OAKS CA
91320-6434
US

IV. Provider business mailing address

1001 NEWBURY RD
THOUSAND OAKS CA
91320-6434
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-2322
  • Fax:
Mailing address:
  • Phone: 805-379-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA FANDINO
Title or Position: BILLING MANAGER
Credential:
Phone: 805-379-2322