MEDICARE: CALIFORNIA ORTHOPAEDIC & SPINE

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	G73590	CA

General Provider Information

NPI Number	:	1952673725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA ORTHOPAEDIC & SPINE

Provider Business Mailing Address
First Line	:	1223 WILSHIRE BLVD STE 935
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 WILSHIRE BLVD STE 935
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5400
Country	:	US
Telephone Number	:	562-490-7278
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	SCOTT RADIN
Credential	:
Telephone Number	:	562-490-7278

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/08/2012

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