# INNOVATIVE SPINE SURGERY

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

## Provider details

- **NPI number:** 1508095894
- **Authorized official:** DR. MORTEZA M FARR D.O. (PHYSICIAN)
- **Authorized official phone:** (831) 713-8879

## Contact information

- **Practice address:** 1575 SOQUEL DR, B, SANTA CRUZ, CA 95065-1700
- **Practice address phone:** (831) 464-6900
- **Mailing address:** 140 PELTON AVE, SANTA CRUZ, CA 95060-6142
- **Mailing address phone:** (831) 713-8879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 020A80782 | CA | Yes |

## Other

- **Enumeration date:** 07/08/2009
- **Last updated:** 07/08/2009