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General NPI Number Information
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NPI Number | 1083162630
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Entity Type | Organization
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Legal Business Name | NORTH END SPINAL TREATMENT
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 1611 W 25TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-4301
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Country | US
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Telephone | 310-833-3795
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Fax | 310-833-2817
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Provider Business Mailing Address
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Address Line | PO BOX 1116
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-1116
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Country | US
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Telephone | 310-833-3795
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Fax | 310-833-2817
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | JOHN CONCA
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Credential |
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Telephone | 310-955-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 193200000X
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License Number State | CA
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