=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871476937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPINAL DISC SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 S MILL AVE STE 101
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-2106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-853-4004
-----------------------------------------------------
Fax | 480-870-6421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 S MILL AVE STE 101
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-2106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-570-1536
-----------------------------------------------------
Fax | 480-870-6421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MOSTAFA MAITA
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 480-570-1536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------