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General NPI Number Information
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NPI Number | 1295107407
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Entity Type | Organization
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Legal Business Name | AMERICAN SPINE
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 31569 CANYON ESTATES DR STE 135
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-0470
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Country | US
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Telephone | 951-734-7246
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Fax | 877-694-3331
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Provider Business Mailing Address
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Address Line | 31569 CANYON ESTATES DR STE 135
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-0470
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Country | US
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Telephone | 951-734-7246
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Fax | 877-694-3331
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Authorized Official
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Title or Position | CEO
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Name | DR. HEATHER BARRETT
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Credential | DC
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Telephone | 951-734-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA52942
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License Number State | CA
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