# INTERVENTIONAL SPINE CENTER, LLC

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

## Provider details

- **NPI number:** 1508318411
- **Authorized official:** JENNIFER BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
- **Authorized official phone:** (615) 234-5954

## Contact information

- **Practice address:** 24012 CALLE DE LA PLATA, SUITE 130, LAGUNA HILLS, CA 92653
- **Practice address phone:** (949) 588-7246
- **Practice address fax:** (877) 854-7581
- **Mailing address:** PO BOX 5105, IRVINE, CA 92616-5105
- **Mailing address phone:** (949) 836-7665
- **Mailing address fax:** (877) 854-7581

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | FNP40048 | CA | Yes |

## Other

- **Enumeration date:** 10/26/2016
- **Last updated:** 03/08/2023