Provider Demographics
NPI:1962769729
Name:THE SPINE AND PAIN CENTER OF ORANGE COUNTY
Entity type:Organization
Organization Name:THE SPINE AND PAIN CENTER OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-732-0303
Mailing Address - Street 1:4980 BARRANCA PKWY
Mailing Address - Street 2:SUITE 195
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4980 BARRANCA PKWY
Practice Address - Street 2:SUITE 195
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8645
Practice Address - Country:US
Practice Address - Phone:949-732-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107041207R00000X, 208VP0000X
207XS0117X
CAA92732207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty