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General NPI Number Information
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NPI Number | 1073707584
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Entity Type | Organization
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Legal Business Name | SAN DIEGO NEUROSURGERY AND SPINE INSTITUTE
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 450 4TH AVE SUITE 405
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City | CHULA VISTA
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State | CA
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Zip | 91910-4426
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Country | US
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Telephone | 760-634-5900
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Fax | 760-634-5905
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Provider Business Mailing Address
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Address Line | 561 SAXONY PLACE SUITE 102
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City | ENCINITAS
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State | CA
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Zip | 92024
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Country | US
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Telephone | 760-634-5900
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Fax | 760-634-5905
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANE TIPTON
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Credential |
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Telephone | 760-634-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | G68540
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License Number State | CA
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