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General NPI Number Information
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NPI Number | 1902800543
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA SPINE AND SPORT MEDICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 1401 AVOCADO AVE STE 709
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-8714
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Country | US
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Telephone | 949-644-5800
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Fax | 949-999-5813
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Provider Business Mailing Address
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Address Line | 1401 AVOCADO AVE STE 709
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-8714
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Country | US
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Telephone | 949-644-5800
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Fax | 949-999-5813
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Authorized Official
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Title or Position | COO
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Name | MS. DELGASH DOSKY
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Credential |
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Telephone | 949-644-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) 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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | Q34724
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA65976
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G53385
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License Number State | CA
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