Provider Demographics
NPI:1407650625
Name:PREMIER ORTHOPEDIC AND SPINE GROUP INC
Entity type:Organization
Organization Name:PREMIER ORTHOPEDIC AND SPINE GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTENELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-337-2589
Mailing Address - Street 1:17525 VENTURA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5111
Mailing Address - Country:US
Mailing Address - Phone:818-986-2861
Mailing Address - Fax:818-638-5762
Practice Address - Street 1:1513 S GRAND AVE STE 380
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3070
Practice Address - Country:US
Practice Address - Phone:310-337-2589
Practice Address - Fax:833-450-5061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER ORTHOPEDIC AND SPINE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-04
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty