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General NPI Number Information
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NPI Number | 1922435411
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Entity Type | Organization
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Legal Business Name | UNIVERSITY SPINE & PAIN CENTER
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 555 PIER AVE SUITE 1
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-3839
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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 | 555 PIER AVE SUITE 1
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-3839
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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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Authorized Official
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Title or Position | CEO
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Name | DR. BAO NGUYEN
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Credential | M.D.
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Telephone | 714-254-5751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | A95636
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License Number State | CA
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