Basic Information
| Provider Information | |||||||||
| NPI: | 1548534738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CENTER OF NEUROSCIENCE AND SPINE, CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 E ARTESIA ST | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917672900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098651020 | ||||||||
| FaxNumber: | 9098651202 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 E ARTESIA ST | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917672900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098651020 | ||||||||
| FaxNumber: | 9098651202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2012 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9098651020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | A87133 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.