Provider Demographics
NPI:1427509033
Name:INTERVENTIONAL SPINE CARE & ORTHOPEDIC REGENERATIVE EXPERTS
Entity type:Organization
Organization Name:INTERVENTIONAL SPINE CARE & ORTHOPEDIC REGENERATIVE EXPERTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-913-9356
Mailing Address - Street 1:PO BOX 8232
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-0232
Mailing Address - Country:US
Mailing Address - Phone:818-913-9356
Mailing Address - Fax:818-369-7177
Practice Address - Street 1:800 S CENTRAL AVE STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4388
Practice Address - Country:US
Practice Address - Phone:818-338-6860
Practice Address - Fax:888-425-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1186922081P2900X, 2081S0010X
CAA118692208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty