# SPINE & NERVE DIAGNOSTIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144628504
- **Authorized official:** VINAY MOOLA REDDY M.D. (MD/PRESIDENT)
- **Authorized official phone:** (916) 772-5325

## Contact information

- **Practice address:** 1528 EUREKA RD STE 103, ROSEVILLE, CA 95661-3047
- **Practice address phone:** (916) 772-5325
- **Practice address fax:** (916) 772-6333
- **Mailing address:** 1528 EUREKA RD STE 103, ROSEVILLE, CA 95661-3047
- **Mailing address phone:** (916) 772-5325
- **Mailing address fax:** (916) 772-6333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204R00000X | Electrodiagnostic Medicine Physician | 00A63460 | CA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 00A63460 | CA | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | 00A83749 | CA | — |
| 208VP0000X | Pain Medicine Physician | 00A83749 | CA | — |
| 208VP0014X | Interventional Pain Medicine Physician | 00A63460 | CA | — |

## Other

- **Enumeration date:** 12/16/2014
- **Last updated:** 06/11/2019