1821426305 NPI number — AMERICAN SPINE PC

Table of content: (NPI 1821426305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821426305 NPI number — AMERICAN SPINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN SPINE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN SPINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821426305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90510-3098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-792-3914
Provider Business Mailing Address Fax Number:
855-898-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 FULLERTON AVE
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92881-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-279-0100
Provider Business Practice Location Address Fax Number:
951-734-7245
Provider Enumeration Date:
10/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIAL
Authorized Official First Name:
KHURAM
Authorized Official Middle Name:
AKBAR
Authorized Official Title or Position:
PRESIDENT/ OWNER
Authorized Official Telephone Number:
310-792-3914

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  A90421 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X , with the licence number: A90421 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6882920002 . This is a "MEDICARE DME PTAN 2" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".