=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356240022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPINE CENTER OF SAN DIEGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2026
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16870 W BERNARDO DR STE 120
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-676-1166
-----------------------------------------------------
Fax | 858-529-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16870 W BERNARDO DR STE 120
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92127-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-676-1166
-----------------------------------------------------
Fax | 858-529-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES L PADILLA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 858-676-1166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------