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General NPI Number Information
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NPI Number | 1215404132
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Entity Type | Organization
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Legal Business Name | HAVEN ORTHOPEDICS & SPINE INSTITUTE INC
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 10390 COMMERCE CENTER DR STE C100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5858
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Country | US
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Telephone | 909-372-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 10390 COMMERCE CENTER DR STE C100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5858
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Country | US
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Telephone | 909-372-0000
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Fax |
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Authorized Official
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Title or Position | MD
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Name | FADY ELIAS
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Credential | MD
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Telephone | 909-372-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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