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General NPI Number Information
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NPI Number | 1952673725
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Entity Type | Organization
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Legal Business Name | CALIFORNIA ORTHOPAEDIC & SPINE
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 1223 WILSHIRE BLVD STE 935
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City | SANTA MONICA
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State | CA
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Zip | 90403-5400
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Country | US
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Telephone | 562-490-7278
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 WILSHIRE BLVD STE 935
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City | SANTA MONICA
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State | CA
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Zip | 90403-5400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | SCOTT RADIN
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Credential |
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Telephone | 562-490-7278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | G73590
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License Number State | CA
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