# SPINE & NERVE DIAGNOSTIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SPINE & NERVE DIAGNOSTIC CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144865726
- **Legal business name:** SPINE & NERVE DIAGNOSTIC CENTER
- **Authorized official:** VINAY MOOLA REDDY (PRESIDENT AND CEO)
- **Authorized official phone:** (916) 772-5325

## Contact information

- **Practice address:** 4200 DOUGLAS BLVD, GRANITE BAY, CA 95746-5902
- **Practice address phone:** (916) 722-5325
- **Mailing address:** 1528 EUREKA RD STE 103, ROSEVILLE, CA 95661-3047
- **Mailing address phone:** (916) 772-5325

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2019
- **Last updated:** 11/07/2019