Provider Demographics
NPI:1154600070
Name:DISC SPORTS AND SPINE CENTER AT NEWPORT BEACH
Entity type:Organization
Organization Name:DISC SPORTS AND SPINE CENTER AT NEWPORT BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-574-0450
Mailing Address - Street 1:13160 MINDANAO WAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6358
Mailing Address - Country:US
Mailing Address - Phone:310-574-0450
Mailing Address - Fax:310-574-0371
Practice Address - Street 1:3501 JAMBOREE RD
Practice Address - Street 2:SUIUTE 1200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2939
Practice Address - Country:US
Practice Address - Phone:949-988-7888
Practice Address - Fax:949-509-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty