Organization Name: | SPINEZONE MEDICAL FITNESS |
NPI Number: | 1396125373 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRANK GRANT (COO) |
Mailing Address: | 2535 Camino Del Rio S Suite 150 San Diego |
State: | CA US |
Postal Code: | 921083754 |
Phone Number: | 6195748770 |
Fax Number: | 8668131235 |
NPI Enumeration Date: | 06/04/2015 |
NPI Last Update Date: | 06/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A34656 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |