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General NPI Number Information
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NPI Number | 1750789053
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Entity Type | Organization
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Legal Business Name | SPINE & NERVE DIAGNOSTIC CENTER
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4420 DUCKHORN DR STE 200
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City | SACRAMENTO
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State | CA
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Zip | 95834-2590
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Country | US
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Telephone | 916-419-9900
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Fax | 916-419-9699
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Provider Business Mailing Address
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Address Line | 1528 EUREKA RD STE 103
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City | ROSEVILLE
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State | CA
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Zip | 95661-3047
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Country | US
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Telephone | 916-772-5325
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Fax | 916-772-6333
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | VINAY REDDY
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Credential | MD
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Telephone | 916-722-5325
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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 | 00A63460
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 00A83749
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 00A83749
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 00A63460
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 00A63460
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License Number State | CA
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