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General NPI Number Information
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NPI Number | 1447880026
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Entity Type | Organization
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Legal Business Name | TITAN SPINE, PLLC
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 675 TOWN SQUARE BOULEVARD SUITE 200 1A
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City | GARLAND
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State | TX
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Zip | 75040
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Country | US
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Telephone | 903-375-0168
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Fax |
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Provider Business Mailing Address
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Address Line | MSC 484 PO BOX 650097
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City | DALLAS
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State | TX
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Zip | 75265-0097
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Country | US
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Telephone | 903-375-0168
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Fax |
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Authorized Official
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Title or Position | LEGAL OPERATION MANAGER
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Name | FELICIA ALDERETE
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Credential |
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Telephone | 210-598-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic 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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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