SAN DIEGO SPINE CENTER, AMC (NPI# 1720280738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720280738 |
| Entity Type | Organization |
| Organization Name | SAN DIEGO SPINE CENTER, AMC |
| Practice Address |
3760 Convoy St 114 San Diego CA 92111-3742 |
| Practice Telephone | 8587158444 |
| Practice Fax Number | 8587158324 |
| Mailing Telephone | 8587158444 |
| Mailing Fax Number | 8587158324 |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-10-16 |
| Authorized Official Name | DR. ERIC STEVEN KORSH (PRESIDENT) |
| Authorized Official Telephone | 8587158444 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
G84012 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICARE PTAN SAN DIEGO OFFICE | FX680A | 01 |
| CA | MEDICARE PTAN FOR INDIO OFFICE | FX680B | 01 |
| Street Address |
3760 CONVOY ST 114 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92111-3742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437159001 | Dorian L Polson | Psychologist | 3760 Convoy St, Ste 118, San Diego, CA 92111-3742 | 2005-07-26 |
| 1790217479 | Jennifer Howard | Speech-Language Pathologist | 3760 Convoy St, Suite 204, San Diego, CA 92111-3742 | 2017-03-31 |
| 1629518204 | Therese Azkoul | Occupational Therapist | 3760 Convoy St, Suite 204, San Diego, CA 92111-3742 | 2017-03-02 |
| 1245770866 | Carol Lieu | Physical Therapist | 3760 Convoy St, Suite 204, San Diego, CA 92111-3742 | 2017-03-01 |
| 1619416245 | Denise Martinez | Physical Therapist | 3760 Convoy St, Suite 101, San Diego, CA 92111-3742 | 2017-02-15 |
| 1750826426 | Christine Gaw | Occupational Therapist | 3760 Convoy St, Ste 201, San Diego, CA 92111-3742 | 2017-01-04 |
| 1154866259 | Alyssa Zafuta | Physical Therapist | 3760 Convoy St, Suite 100, San Diego, CA 92111-3742 | 2016-12-27 |
| 1134670011 | Therapy Specialists | Physical Therapist | 3760 Convoy St, Suite 204, San Diego, CA 92111-3742 | 2016-10-17 |
| 1477007961 | Cathy Mizunuma | Speech-Language Pathologist | 3760 Convoy St, Suite 204, San Diego, CA 92111-3742 | 2016-08-12 |
| 1225486376 | Rebecca Vandervolgen | Speech-Language Pathologist | 3760 Convoy St, Ste. 204, San Diego, CA 92111-3742 | 2016-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982220653 | Karen Elizabeth Mitchell | Registered Nurse | County of San Diego California Children's Services (ccs, 6991 Balboa Ave, (room 70), San Diego, CA 92111 | 2020-06-18 |
| 1912523804 | Access Medical, Inc. | Durable Medical Equipment & Medical Supplies | 4150 Convoy Street, Suite A, San Diego, CA 92111 | 2020-06-17 |
| 1154944551 | Mei Ling Milan Szeto | Student in an Organized Health Care Education/Training Program | 7917 Ostrow Street, Suite A, San Diego, CA 92111 | 2020-05-20 |
| 1346893831 | Leticia Isabel Peralta | Assistant Behavior Analyst | 563 Balboa Avenue. Number 521, San Diego, CA 92111 | 2019-07-23 |
| 1295204394 | Demetria Serfas | Behavioral Analyst | 563 Balboa Ave #521, San Diego, CA 92111 | 2018-11-19 |
| 1568981678 | Ross Psychology | Psychologist | 4883 Ronson Court, Suite K, San Diego, CA 92111 | 2017-09-11 |
| 1225554587 | Bianca Acosta | Technician, Other | 563 Balboa Ave. #521, San Diego, CA 92111 | 2017-08-18 |
| 1194240085 | Kazuhiro Kato | Dentist | 3707 Convoy St., San Diego, CA 92111 | 2017-08-11 |
| 1073038527 | Joanne Epps-yentz | Licensed Vocational Nurse | 7414 Mesa College Dr. Apt 47, San Diego, CA 92111 | 2017-08-06 |
| 1184158446 | Positive Behavior Supports Corp | Community/Behavioral Health | 563 Balboa Ave, 521, San Diego, CA 92111 | 2017-04-13 |
| Find all providers in zip 92111 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730508979 | Abhiram Gande | Orthopaedic Surgery | 7485 Mission Valley Rd Ste 104a, San Diego, CA 92108-4422 | 2014-04-15 |
| 1659713725 | Nicole Claudette Record | Orthopaedic Surgery | 6190 Cornerstone Ct E Ste 212, San Diego, CA 92121-4701 | 2013-07-18 |
| 1073677811 | La Jolla Spine Institute Medical Group, Inc. | Orthopaedic Surgery | 6719 Alvarado Rd., Suite 308, San Diego, CA 92120 | 2006-12-19 |
| 1245281856 | Jean-jacques Abitbol | Orthopaedic Surgery | 7625 Mesa College Dr Ste 310a, San Diego, CA 92111-5343 | 2006-05-16 |
| 1962018044 | Excel Spine Center | Orthopaedic Surgery | 6719 Alvarado Rd Ste 308, San Diego, CA 92120-5268 | 2020-09-23 |
| 1114306347 | Preetpaul Singh Bagi | Orthopaedic Surgery | 200 W Arbor Dr, San Diego, CA 92103-9000 | 2015-05-20 |
| 1629456553 | John D Attenello | Orthopaedic Surgery | 200 W Arbor Dr, San Diego, CA 92103-9000 | 2015-05-12 |
| 1972923704 | Jacob H Fennessy | Orthopaedic Surgery | 200 W Arbor Dr, San Diego, CA 92103 | 2014-04-20 |
| 1285952655 | Oliver O Tannous | Orthopaedic Surgery | 350 Dickinson St, Suite 121, Mc 8894, San Diego, CA 92103-1913 | 2010-05-11 |
| 1760632947 | Ali Bagheri | Orthopaedic Surgery | 9333 Genesee Ave Ste 350, San Diego, CA 92121-2103 | 2008-09-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.