1659915015 NPI number — SPINEZONE MEDICAL FITNESS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659915015 NPI number — SPINEZONE MEDICAL FITNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINEZONE MEDICAL FITNESS, INC.
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:
Provider Other Organization Name Type Code:
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:
1659915015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7525 METROPOLITAN DR STE 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-316-7979
Provider Business Mailing Address Fax Number:
866-813-1235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1828 OCEANSIDE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-3452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-316-7979
Provider Business Practice Location Address Fax Number:
866-813-1235
Provider Enumeration Date:
10/29/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CASTLE
Authorized Official First Name:
IVANIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER / CREDENTIALING
Authorized Official Telephone Number:
619-432-4634

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com