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General NPI Number Information
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NPI Number | 1679100622
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Entity Type | Organization
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Legal Business Name | SPINE AND PAIN CENTER INC
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 555 PIER AVE STE 1A
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-3800
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Country | US
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Telephone | 424-488-0500
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Fax | 424-488-0498
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | BAO THAI NGIUYEN
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Credential | MD
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Telephone | 424-488-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation 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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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