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General NPI Number Information
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NPI Number | 1659597789
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE SPINE CARE INSTITUTE - INCORPORATED
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1510 S CENTRAL AVE STE 230
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City | GLENDALE
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State | CA
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Zip | 91204-2583
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Country | US
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Telephone | 818-548-1635
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Fax | 818-247-6157
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Provider Business Mailing Address
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Address Line | 1510 S CENTRAL AVE STE 230
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City | GLENDALE
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State | CA
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Zip | 91204-2583
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Country | US
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Telephone | 818-548-1635
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARTYOUN ISAAK YOUSIF
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Credential | M.D.
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Telephone | 818-548-1635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A40779
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License Number State | CA
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