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General NPI Number Information
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NPI Number | 1104208685
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Entity Type | Organization
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Legal Business Name | RENO SPINE CENTER
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1475 TERMINAL WAY STE C1
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City | RENO
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State | NV
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Zip | 89502-3430
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Country | US
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Telephone | 775-322-1230
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Fax | 775-322-1238
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Provider Business Mailing Address
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Address Line | 1475 TERMINAL WAY STE C1
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City | RENO
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State | NV
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Zip | 89502-3430
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Country | US
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Telephone | 775-322-1230
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Fax | 775-322-1238
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Authorized Official
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Title or Position | OWNER
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Name | MR. ARDAVAN M ASLIE I
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Credential | MD
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Telephone | 775-322-1230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14877
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License Number State | NV
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