Healthcare Provider Details

I. General information

NPI: 1770463838
Provider Name (Legal Business Name): SPINATOMYMED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14624 SHERMAN WAY STE 300
VAN NUYS CA
91405-2288
US

IV. Provider business mailing address

14624 SHERMAN WAY STE 300
VAN NUYS CA
91405-2288
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-1505
  • Fax: 818-901-7705
Mailing address:
  • Phone: 818-901-1505
  • Fax: 818-901-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIGITTE ROZENBERG
Title or Position: OWNER
Credential:
Phone: 818-901-1505