MEDICARE: CALIFORNIA SPORTS AND SPINE INSTITUTE, PC

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	208100000X	Physical Medicine & Rehabilitation Physician	A118692	CA
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A118692	CA
3	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	A118692	CA

General Provider Information

NPI Number	:	1801327606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA SPORTS AND SPINE INSTITUTE, PC

Provider Business Mailing Address
First Line	:	PO BOX 8323
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91224-0323
Country	:	US
Telephone Number	:	818-913-9356
Fax Number	:	888-425-9079

Provider Business Practice Location Address
First Line	:	317 S BRAND BLVD STE A-104
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1701
Country	:	US
Telephone Number	:	818-338-6860
Fax Number	:	888-425-9079

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MAXIM MORADIAN
Credential	:	MD
Telephone Number	:	818-913-9356

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	02/20/2026

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