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General NPI Number Information
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NPI Number | 1225267388
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Entity Type | Organization
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Legal Business Name | SPECTRUM MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 5211 E WASHINGTON BLVD SUTIE 18
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City | COMMERCE
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State | CA
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Zip | 90040-3959
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Country | US
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Telephone | 714-293-4571
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Fax |
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Provider Business Mailing Address
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Address Line | 149 S. BARRINGTON #754
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City | LOS ANGELES
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State | CA
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Zip | 90049
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Country | US
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Telephone | 714-293-4571
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Fax | 310-471-9521
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Authorized Official
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Title or Position | VP
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Name | AMIN NIA
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Credential | D.C.
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Telephone | 714-293-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number |
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License Number State |
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