MEDICARE: SAN DIEGO NEUROSURGERY AND SPINE INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1144374687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO NEUROSURGERY AND SPINE INSTITUTE

Provider Business Mailing Address
First Line	:	561 SAXONY PL STE 102
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-7700
Country	:	US
Telephone Number	:	760-634-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 EUCLID AVE STE 202
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2952
Country	:	US
Telephone Number	:	760-634-5900
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DIANE TIPTON
Credential	:
Telephone Number	:	760-634-5900

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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