Basic Information
Provider Information | |||||||||
NPI: | 1942885835 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MONTEREY SPINE & JOINT PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3168 | ||||||||
Address2: |   | ||||||||
City: | SALINAS | ||||||||
State: | CA | ||||||||
PostalCode: | 939123168 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8314240807 | ||||||||
FaxNumber: | 8314243408 | ||||||||
Practice Location | |||||||||
Address1: | 220 SAN JOSE ST | ||||||||
Address2: |   | ||||||||
City: | SALINAS | ||||||||
State: | CA | ||||||||
PostalCode: | 939013901 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8314240807 | ||||||||
FaxNumber: | 8314243408 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/12/2021 | ||||||||
LastUpdateDate: | 06/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CHAVARRIA | ||||||||
AuthorizedOfficialFirstName: | DORA | ||||||||
AuthorizedOfficialMiddleName: | ELIA | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8313754105 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/22/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 2081P2900X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 207XS0117X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
ID | Type | State | Issuer | Description | 2224637 | 05 | CA |   | MEDICAID |